桥接组合式内固定系统治疗股骨干骨折术后骨不连的临床观察

Clinical observation of bridging modular internal fixation system in the treatment of nonunion after femoral shaft fracture

目的观察桥接组合式内固定系统治疗股骨干骨折术后骨不连的临床效果。方法自2013年1月~2016年2月对65例股骨干骨折术后骨不连患者进行重新复位内固定治疗,治疗组35例采用桥接组合式内固定系统固定+自体髂骨移植治疗,对照组30例采用重新复位钢板+自体髂骨移植治疗,观察内固定是否松动、断裂,骨折愈合情况,骨折愈合时间等。结果两组骨折愈合时间比较,治疗组临床愈合时间优于对照组(P<0.05),术后并发症少,临床有效率优于对照组,两组比较,差异有统计学意义。患肢功能恢复情况根据Johner-Wruh标准评价:治疗组优30例,良2例,中3例,无差病例,优良率为91.43%;对照组优20例,良3例,差7例,优良率为83.33%。结论桥接组合式内固定系统作为一种新的有限接触内固定器材,整体锁定、多维固定,有效控制旋转和螺钉拔出,对固定段无应力遮挡效应,有效保护骨折端血供,有利于骨不连的愈合。

Objective To observe the clinical effect of bridging modular internal fixation system in the treatment of nonunion after femoral shaft fracture. Methods 65 patients with nonunion after femoral shaft fracture from January 2013 to February 2016 were treated with repositioning and internal fixation. 35 patients in the treatment group were treated with bridging modular internal fixation system and autologous iliac bone graft. 30 cases in the control group were treated with repositioning plate and autologous iliac bone graft.Whether the internal fixation was loose and broken, the fracture healing status and healing time were observed. Results The healing time between two groups was corn- pared, the clinical healing time in the treatment group was better than that of the control group（P〈O.05）. The tive complications in the treatment group were fewer than those in the control group and the clinical healing postopera- rate in the treatment was better than that of the control group. The difference between the two groups was statistically significant. The recovery of limb function was evaluated according to Johner-Wruh criteria. 30 cases were excellent in the treat- ment group, with good in 2 cases and poor in 3 cases, and without bad cases. The excellent and good rate was 91.43% in the treatment group. 20 cases in the control group were excellent, with good in 3 cases and bad in 7 cases, and the excellent and good rate was 83.33%. Conclusion The bridging modular internal fixation system, as a new finite contact internal fixation device, has the advantages of integral locking, multidimensional fixation, effective control of rotation and screw pull, no stress shielding effect on the fixed section and effective protection of bone supply, which is con- ducive to the healing of nonunion.