带锁髓内钉固定四肢骨折术后骨不连原因分析及防治措施

Analysis of factors influencing bone nonunion after limb fracture fixation with interlocking intramedullary nail corresponding measures for prevention

目的：讨论分析带锁髓内钉固定四肢骨折术后骨不连的原因及相应的防治措施。方法：本院自2005年1月～2013年12月对286例四肢长干骨骨折采用带锁髓内钉治疗，发生延迟愈合9例，骨不连12例，从多方面分析其原因并提出相应防治措施。结果：12例骨不连病例经采用髂骨游离移植及改变内固定方式，均获得骨性愈合。结论：医源性因素是导致带锁髓内钉固定四肢骨骨折术后骨不连的主要原因，只有严格操作规范，选用正确的内固定、有骨缺损时植骨、遵循生物学固定（ biological osteosynthesis BO）原则、科学的功能锻炼，才是避免骨不连发生的关键。

Objective：To discuss and analyze the factors influencing nonunion after limb fracture fixation with interlocking intramedullary nail and the corresponding measures for prevention. Methods：A total of 286 patients were treated for long bone fracture of limbs with interlocking intramedullary nail from January 2005 to December 2013. The delayed healing occurred in 9 cases,while the nonunion was in 12 cases. The author analyzed the cause from many aspects and puts forward the corresponding prevetion measures for prevention. Results：The twelve patients fo bone nonunion were treated by iliac bone graft and changing the use of internal fixation,and bone healing was obtained. Conclusion：Latrogenic was the main factor leading to nonunion after fracture fixation with interlocking intramedullary nail. Only the strict standard operation,selection of proper internal fixation,necessary bone graft,following the principles of biological osteosynthesis （ BO） ,and scientific functional exercises should be the key to avoiding the occurrence of nonunion.