附加侧板联合植骨治疗股骨干骨折髓内钉固定后骨不连

Augmentation plating with bone grafting for nonunions of femoral shaft fractures after intramedullary nail fixation

背景:对于股骨干粉碎性骨折、非峡部骨折、骨缺损等髓内钉固定后骨不连患者,更换髓内钉治疗的临床疗效并不理想。目的:对18例应用附加侧板联合植骨治疗的股骨干骨折髓内钉固定后非感染性骨不连患者进行回顾性分析,观察附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效。方法:选择2001年4月至2011年6月在武警江苏省总队医院住院的股骨干骨折髓内钉固定后非感染性骨不连患者18例。所有患者均保留原髓内钉,附加6-11孔动力加压钢板或锁定加压钢板,远、近端各拧入2-4枚普通或锁定、单或双皮质螺钉,同期行自体髂骨植骨术。随访观察患者骨折愈合情况。根据Tohner-Wrnch标准评定附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连的临床疗效。结果与结论:所有病例均获得随访,随访时间6-21个月,平均16个月。X射线片结果显示治疗后患者骨性愈合率为100%;其中13例患者于治疗后6-9个月达到骨性愈合,另5例患者于治疗后10-11个月达到骨性愈合。Tohner-Wrnch标准评定结果显示附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连的优良率为100%。且植入物无腐蚀、断裂等情况,无植入物宿主反应。可见保留原髓内钉、附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连临床疗效满意,是一种比较理想的治疗方法。

BACKGROUND： For the patients with nonunions of femoral shaft comminuted fractures, non-isthmus and bone defects after treated with intramedultary nail fixation, the clinical efficacy of replacing the intramedullary nail is not satisfactory.OBJECTIVE： To observe the therapeutic effect of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation through a retrospective analysis of 18 cases.METHOIDS： All the 18 cases with aseptic nonunions of femoral shaft fractures after intramedullary nail fixation were selected from Jiangsu Provincial Corps Hospital of the Chinese People＇s Armed Police Force from April 2001 to June 2011. All patients retained the original intramedullary nail, augmentation plating of 6 to 11 holes . dynamic compression plate or locking compression plate, wrenching 2 to 4 screws （locking or common, single or double cortex） in the proximal or distal end. All cases undertook the autogenoas iliac crest bone grafting at the same time. The follow-up results were used to observe the fracture healing of the patients. The clinical effect of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation was evaluated according to the Tohner-Wrnch standard.RESULTS AND CONCLUSION： All cases wore followed-up for 6-21 months, average in 16 months. X-ray film showed that the bone healing rate was 100%; among the cases, 13 cases achieved osseous union within 6-9 months, while the other five patients achieved osseous union within 10-11 months. Tohner-Wmch standard assessment results showed the bone healing rate of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation was 100%, no corrosion, breakage or hosting reaction of implant was found in all patients, Retaining the original intramedullary nail and augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedullary nail fixation has a satisfied clinical efficacy, it is an ideal treatment method.