钢板治疗股骨干骨折失败原因分析

Reasons for failure of plate fixation in femoral shaft fractures

目的探讨采用钢板固定股骨干骨折术后失败的原因。方法回顾13例钢板治疗的股骨干骨折失败患者病史资料及X射线片,其中男性9例,女性4例;年龄19~62岁,平均年龄42.3岁,分析内固定失败的原因。结果术后在3.6~10.0个月出现内固定失败,其中9例术后接骨板断裂,2例螺钉断裂,1例螺钉松动拔出,1例钢板弯曲。内固定技术与理念理解错误8例,钢板对侧缺少骨皮质支撑5例,钢板放置偏前侧3例,术后负重过早4例。结论股骨干骨折钢板固定失败与内固定技术及理念掌握、钢板放置位置及对侧皮质完整、科学合理的康复指导等有关,其中内固定技术及理念掌握为重点。

Objective To investigate the reasons for the failure of internal fixation with plate in femoral shaft fractures. Methods The medical history and X-ray of 13 patients with failed plate internal fixation in femoral shaft fractures were enrolled, which included 9 males and 4 females, aged 19- 62 years old with mean age of 42.3. The reasons for the failure of plate fixation were analyzed. Results The internal fixation failed after 3.6- 10.0 months. Among these failures, plate breaks showed in 9 cases, screw break showed in 2 cases, screw loosening removal showed in 1 case and plate bended showed in 1 case. Internal fixed technology and concept were incorrect in 8 cases, plate support by the opposite cortical bone was incomplete in 5 cases, plate located anterior in 3cases, and 4 cases showed early activity with load. Conclusion It is demonstrated that the failed plate treatment in femoral shaft fractures are related with internal fixed technology, location of plate, completion of opposite cortical bone and early activity with load.Among these reasons, the technology and concepts of internal fixation are considered to be the key points.