外固定架辅助髓内钉技术治疗股骨畸形和股骨干骨折不愈合

Management of nonunion of femoral shaft fracture and deformity of femur with fixator-assistednailing

目的探讨外固定架辅助髓内钉（fixator assist nailing，FAN）技术治疗股骨畸形、股骨十骨折不愈合伴畸形和畸形愈合的疗效。方法回顾性分析在2008年1月至2011年12月采用FAN技术治疗8例股骨干骨折不愈合伴畸形、3例维牛素D抵抗性佝偻病性股骨畸形、2例股骨干骨折畸形愈合．．男11例，女2例；年龄16-50岁，平均33岁。10例采用一期手术，3例采用二期手术。12例采用单边外固定架，l例采用环形外固定架。8例采用顺行髓内钉，5例采用逆行髓内钉。2例患者采用自体髂骨植骨，l例骨痂剪碎后植骨。结果12例患者获得完整随访，随访时间12-48个月，平均21个月。7例股骨干骨折不愈合的患者骨折在术后3-6个月愈合，平均3．8个月。5例股骨畸形行截骨术的患者截骨端在术后3-5个月（平均3．5个月）愈合。根据Paley评分标准，9例为优，2例为良，1例为可。术前下肢不等长（48．2±23．0）mm，术后为（27．3±24．6）mm，肢体长度增加4．6-41．0mm（平均23．3mm）。术前机械轴偏向（27．5±24．4）mm，术后（6．3±8．3）mm。末发生感染和神经、血管损伤。结论FAN技术结合了外固定架安全、微创、便于调节，可准确矫正畸形优点和髓内钉固定患者依从性高特点，可有效地治疗代谢性骨病引起的股骨畸形、股骨干骨折不愈合伴畸形和畸形愈合。

Objective To evaluate the effect of fixator-assisted nailing （FAN） technique for thetreatment of femoral deformity, nonunion of femoral shaft fracture with deformity and malunion. Methods The data of 8 patients with nonunion of femoral shaft fracture with deformity, 3 patients with femoral deformity caused by Rickets disease and 2 patients with femoral fracture malunion who received treatment FAN technique was retrospectively analyzed. There were 11 males and 2 females, with an average age of 33 years （range, 16-50 years）. One-stage operation was used in 10 patients： after the fracture was distracted and reduced with external fixator, an intramedullary nail was used for final fixation. Two-stage strategy was used in 3 patients. Unilateral external fixator was used in 12 patients, ring fixator was used in 1 patient. Femoral intramedullary nailing was used in 8 patients, retro-femoral intramedullary nailing was used in 5 patients; autograft from eallus of fracture site was used in 1 patient. Results The 12 patients were followed up for 12-48 months with an average of 21 months. The fractures of 7 patients united 3-6 months （average, 3.9 months） later after the operation. The osteotomy site of 5 patients united 3-5 months （average, 3.5 months） later after the operation. The results were evaluated aeeording to the Paley classification of functional results. There were 9 eases rated as excellent, 2 as good and 1 as fair. The lower leg diserepaney （LLD） before and after operation was （48.2±23.0） mm and （27.3±24.6） mm, individually; the length of limb inereased 4.6-41.0 mm （average, 23.3 mm）. The pre- and post-operative MAD was （27.5±24.4） mm and （6.3±8.3） mm. There was no neurovascular injury or infeetion occurred in any of the patients. All the patients were satisfied with the result of treatment. Conclusion FAN teehnique combines the aceuracy, minimal invasiveness and safety of external fixation together with patient eomplianee of IM nail. It is an effective method to manage nonunion of femoral shaft fracture with deformity, malunion of femur, and femoral deformity cause by riekets.