带锁髓内钉治疗股骨骨不连

Interlocking intramedullary nail for the treatment of femoral nonunion

目的:分析股骨骨不连原因,观察带锁髓内钉治疗股骨骨不连的临床效果。方法:2001年1月至2009年1月,采用带锁髓内钉治疗31例股骨骨不连,男19例,女12例;年龄18～73岁,平均32.5岁。其中骨不连发生在股骨干24例,股骨远端7例。股骨干骨不连采用标准带锁髓内钉治疗,股骨远端骨不连采用股骨髁上带锁髓内钉治疗。一般行切开带锁髓内钉固定及自体骨移植,所有病例均使用扩髓技术。结果:31例全部获得随访,时间14～72个月,平均23个月。30例获骨性愈合,愈合时间3～6个月,平均4.6个月;另1例髓内钉固定后再次给予植骨后愈合。髋关节功能全部正常,术后1年膝关节行HSS评分平均为(89.97±5.21)分。结论:采用带锁髓内钉治疗股骨骨不连具有固定可靠,稳定性好的优点,有利于肢体、关节早期功能锻炼。扩髓结合自体骨移植可获良好临床效果。

Objective：To analyze the causes of femoral nonunion,and to investigate clinical effects of interlocking intramedullary nails for the treatment of femoral nonunion. Methods：From January 2001 to January 2009,31 patients with femoral nonunion were treated with interlocking intramedullary nail. Among the patients,19 patients were male and 12 patients were female,ranging in age from 18 to 73 years,with an average of 32.5 years. Twenty-four patients had nonunion of femoral shaft,and 7 patients had nonunion at the distal femur. The patients with nonunion of femoral shaft were treated with normal interlocking intramedullary nails and the patients with nonunion at the distal femur were treated with supracondylar femur interlocking nails. The reamed technique was used in all patients. All the patients were treated with internal fixation with interlocking intramedullary nails and autogenous bone transplantation. Results：All the patients were followed up,and the duration ranged from 14 to 72 months,with a mean of 23 months. Thirty patients got bony union,and an average healing time was 4.6 months （3 to 6 months）. Another patient healed after bone re-transplantation and intramedullary nail fixation. All the hip joints recovered to normal function. The average HSS knee score was 89.97±5.21 at 1 year after operation. Conclusion：The use of interlocking intramedullary nail for the treatment of femoral nonunion has follow advantages：reliable fixation,good stability,in favor of early functional exercise of extremities and joints. Reaming combined with autologous bone graft may be good treatment methods.