钢板加异体骨板固定治疗股骨干骨折髓内钉固定术后骨折不愈合

Treatment of nonunion of femoral shaft fracture after initial locked intramedullary fixation with plate and xenogenic bony plate

目的 ：探讨采用钢板加对侧异体骨板固定治疗股骨干骨折交锁髓内钉固定术后骨折不愈合的临床疗效。方法：分析自2006年2月至2013年6月21例股骨干骨折髓内钉固定术后不愈合患者采用钢板加对侧异体骨板固定治疗,男12例,女9例;年龄18-62岁,平均34.8岁。骨折不愈合时间9-18个月,平均12.8个月。术后采用Merchan标准评定临床疗效。结果：21例患者伤口均Ⅰ期愈合,无感染、内固定物断裂、脂肪栓塞、旋转畸形及明显的短缩畸形等并发症。术后随访8-24个月,平均13.2个月。19例患者术后达到骨性愈合,平均愈合时间为6.2个月（4-9个月）,2例出现骨折延迟愈合,经7-13个月观察获得骨性愈合。术后1年膝关节功能按Merchan标准评定：优13例,良6例,差2例。结论 ：应用钢板加对侧异体骨板固定治疗股骨干骨折髓内钉固定术后骨折不愈合具有治愈率高,并发症少,术后功能恢复良好的特点,能够提高骨折稳定性及促进骨痂生长。

Objective：To investigate the clinical effects of plate and xenogenic bony plate for the treatment of nonunion of femoral shaft fracture after initial fixation with locked intramedullary nailing. Methods：From February 2006 to June 2013,21 cases with nonunion of femoral shaft fracture after initial fixation with locked intramedullary nailing were treated with femoral plate and contralateral xenogenic bony plate. There were 12 males and 9 females with an average age of 34.8 years old（ranging from 18 to 62 years）. The time of nonunion was 9 to 18 months（averaged 12.8 months）. The clinical outcomes of the treatment were evaluated by Merchan assessment. Results：All of the patients were primary healing,and on complications such as infection,fat embolism,internal fixation breaking or rotational deformity,shortening were occurred. All the cases were followed up for 13.2 months（ranging from 8 to 24 months）. Nineteen cases were bone healed,the time of union averaged 6.2 months（ranging from 4 to 9 months）. Two cases appeared delayed union and gained bony union after 7 to 13 months＇ observation. According to the criterion of Merchan,the results were excellent in 13 cases,good in 6 cases,poor in 2 cases. Conclusion：Treatment of nonunion of femoral shaft fracture after initial locked intramedullary fixation with plate and xenogenic bony plate has advantages of high curative rate and low complications,good postoperative function recovery,it is a reliable treatment to elevate the stability of fixation and promote the osteogenesis.