股骨骨折髓钉固定术后延迟愈合及不愈合原因分析

The Analysis about the Cause of Delayed Union and Nonunion on the Application of Intramedullary Nail Fixation in Femoral Shaft Fractures of 43 Cases

目的回顾性分析应用髓内钉治疗股骨干骨折术后发生延迟愈合及不愈合的原因。方法收集2002—2009年使用髓内钉内固定治疗股骨干骨折术后发生延迟愈合、不愈合病例43例,综合分析各病例的受伤机制及影像学资料并进行X线分型,重新进行手术内固定、植骨、骨髓注射等治疗。结果对所有病例进行随访,最长8年,最短10个月,平均随访时间41.9个月。临床疗效评定,优20例,良15例,中5例,差3例。结论在骨折治疗过程中,影响骨折愈合的因素是多种多样的,良好的解剖复位为骨折断端的接触和稳定提供了条件;同时需要密切术后随访,定期行影像学检查,实时监测骨折愈合的进程,制订合理的康复治疗方案,及时消除影响骨折愈合的因素,才能最终达到治疗目的,尽早恢复肢体功能。

Objective Retrospective tracking of the causes and related analysis of postoperative delayed union and nonunion on the application of intramedullary nails in femoral shaft fracture.Methods From year 2002 to 2009,43 Cases were collected which got delayed union and nonunion on the application of intramedullary nail fixation in femoral shaft fractures after operation,Comprehensively analyzing the injury mechanism and the imaging data of all cases,classifying x-ray and using therapy of re-fixation、bone grafting、treatment of bone marrow injection,and so on.Results All patients were followed-up,average time was 41.9 months（10 months～8 years）.Clinical results were excellent in 20 cases,good in 15 cases,common in 5 cases,poor in 3 cases.Conclusion During the clinical treatment of fracture,there are the following factors affect fracture healing.Good anatomical reduction provide conditions for the contactment and stability of fractures,at the same time close postoperative follow-up is needed,examining images regularly,It is important to process real-time monitoring of fracture healing,formulate a reasonable treatment and rehabilitation programs,timely elimination of the factors that affect fracture healing,ultimately attain the therapeutic purposes and restore the function of limbs as soon as possible.