钢板结合异体骨板治疗股骨干内固定术后再骨折

Treatment of refracture in plate-screw fixation of femoral shaft with plate and xenogenic bony plate

目的:探讨钢板结合异体骨板治疗股骨干钢板内固定术后再骨折的疗效。方法:股骨干钢板内固定术后再骨折13例,其中男8例,女5例;年龄14～57岁,平均31.2岁。粉碎性骨折7例,斜形骨折4例,横形骨折2例。8孔股骨有限接触加压钢板5例,8孔上肢有限接触加压钢板2例,6孔股骨有限接触加压钢板2例,8孔兰氏钢板4例。钢板断裂均发生在骨折端邻近钉孔处。全部采用有限接触加压钢板(LC-DCP)加对侧异体脱蛋白骨板股骨双固定及自体髂骨移植术。结果:13例均获得随访,时间16～40个月,平均32个月,平均骨折愈合时间为9个月,均恢复下肢行走和负重的功能。术后1年膝关节功能按Merchan标准评定:优7例,良4例,可1例,差1例,优良率84.6%(11/13)。结论:自体髂骨植骨钢板结合骨板内固定治疗股骨干再骨折效果好,可以达到骨折牢固固定的目的。

Objective：To evaluate curative effect of plate and xenogenic bony plate were applied in refracture in plate - screw fixation of femoral shaft. Methods ：Thirteen cases of refracture in plate-screw fixation of femoral shaft included 8 males and 5 females,average age was 31.2 years ranging from 14 to 57. Fracture type was comminuted fracture in 7 cases,oblique fracture in 4 cases,transverse fracture in 2 cases. Fixation type used eight holes femoral LC-DCP in 5 cases,eight holes epipodite LC-DCP in 2 cases ,six holes femoral LC-DCP in 2 cases ,8 holes La-Plate in 4 cases. All the patients were treated by femoral LC-DCP and xenogenic bony plate. Results： All of the patients were followed up from 16 to 40 months with average of 32 months. All cases had undergone only one operation and achieved bony union. Average time of bony union was 9 months. The lower limbs resumed walk and beared a heavy burden. According to criterion of Merchan,the results were excellent in 7 cases, good in 4, fair in 1 and poor in 1, the excellent and good rate of knee function was 84.6% （11/13 ）in one year after operation. Conclusion：Treatment of refracture in plate-screw fixation of femoral shaft with armor plate and xenogenic bony plate is a reliable treatment.