股骨干骨折髓内钉固定后非感染性骨不连的原因分析及治疗

Cause Analysis and Related Treatment of Aseptic Nonunions of Femoral Shaft Fractures after Femoral Nailing

目的探讨股骨干骨折带锁髓内钉固定术后出现非感染性骨折不愈合及延迟愈合的原因,以及再次手术治疗的方法和疗效。方法回顾性分析我院2008年6月至2013年12月收治的股骨干骨折髓内钉固定术治疗的患者389例,其中骨折不愈合患者31例。分析造成骨折不愈合及延迟愈合的原因。治疗方法采用早期髓钉动力化的方法,如动力化后仍未愈合,采用骨折断端带蒂骨皮质剥离加自体骨植骨的方法,随访再次手术后的效果。结果股骨干中段1/3是股骨干骨折后经髓内钉固定治疗后骨折不愈合的易发部位。骨折不愈合的原因与原始治疗方法、骨折类型等密切相关。早期髓钉动力化可促进骨折愈合;单纯髓钉动力化后骨折仍难以愈合,行带蒂骨皮质剥离加自体骨植骨的方法可促进骨折愈合。结论股骨干骨折带锁髓内钉固定术后非感染性骨折不愈合的原因既有自身因素,又存在手术干预过程的力学、生物学因素,应根据其出现的原因及特点制定适当的治疗方案。

Objective To investigate the causes and treatment of femoral shaft fracture aseptic nonunion and delayed union after interlocking intramedullary nailing. Methods In this study,389 cases from the orthopedic ward of our Hospital since July 2008 to December 2013 of femoral shaft fractures were treated with femoral nailing,31 patients with bone aseptic nonunion and delayed union after interlocking intramedullary nailing for femoral shaft fracture were treated. These patients were retrospectively analyzed. The early treatment methods was dynamization of intramedullary nail. If not yet healing,using pedicled bone cortex peel and autogenous iliac bone graft. The clinical outcomes of the secondary treatment were observed. Results The middle femoral 1 /3 femoral shaft was the frequently site of nonunion. The cause of nonunion was closely related with the original treatment,fracture type. Early dynamization of intramedullary nail could promote the healing of fracture; for dystrophic fracture nonunion,simple intramedullary nail force after fracture was difficult to heal,method of pedicled bone cortex stripping plus autologous iliac bone graft can promote fracture healing. Conclusion Many factors may contribute to fracture nonunion and delayed union after interlocking intramedullary nail fixation. Clinical outcomes of surgical treatment are good for nonunion and delayed union of femoral shaft fracture.