钢板系统治疗髓内固定失败的股骨无菌性骨不连疗效观察

Treatment of femur aseptic non-unions after intramedullary nailing interfixation with locking plate

目的探讨保留髓内钉添加锁定钢板治疗股骨骨折髓内钉固定失败术后无菌性骨不连的疗效。方法回顾性分析2010年1月至2015年1月新疆自治区人民医院骨科中心收治的因髓内钉固定失败而造成的股骨无菌性骨不连的患者18例,其中男性10例,女性8例;年龄35~75岁,平均(49±5)岁;骨不连时间6~34个月,平均(17.6±2.3)个月。所有病例均采用保留原髓内钉添加锁定钢板固定联合自体髂骨骨移植术进行治疗,观察患者术后下地活动时间、骨折愈合时间、术后并发症等。结果 18例患者均获得随访,随访时间6~20个月,平均(12.0±1.4)个月。骨不连均愈合,愈合时间5~14个月,平均(8.3±1.6)个月。1例出现切口表面感染,经治疗后痊愈;患者术后VAS评分由(6.0±1.3)分降至(2.0±1.4)分,差异有统计学意义(t=7.312,P<0.05),术前及末次随访Johner-wruch评分优良率差异有统计学意义(X^2=28.000,P<0.05)。所有患者无畸形愈合。结论锁定钢板联合自体髂骨植骨治疗股骨干骨折髓内钉固定术后无菌性骨不连疗效确切、可靠,可用于股骨干骨折髓内钉固定术后的无菌性骨不连。

Objective To investigate the therapeutic efficacy of locking plate with intramedullary nail rerserving fixation in the treatment of femoral nonunions after intramedullary fixation. Methods From January 2010 to January 2015, a total of 18 consecutive patients with femoral nonunions after intramedullary nailing interfixation were included. There were 8 females and 10 males with a mean age of（49 ± 5） years（range 35-75 years）, non-union time last for 6-34 months, mean（17.6±2.3） months. All patients were treated with intramedullary reserving locking plate fixation combined with autogenous iliac grafting. The postoperative activity out of bed days, bone healing time, complications were evaluated. Results All patients were followed up for 6-20 months [average（12.0±1.4） months]. All patients achieved solid union [5-14 months,average（8.3 ± 1.6） months]. Only one case suffered superficial surgical site infection. Postoperative VAS score was decreased from（6.0 ± 1.3） preoperatively to（2.0 ± 1.4）, differences was statistically significant（t=7.312, P〈0.05）. so was the Johner-wruch score（X2=28.000, P〈0.05）. Conclusion The locked plate combine with iliac bone grafting is a effective solution for femoral nonunion after intramedullary fixation, it can be applied for patients have femoral nonunion after intramedullary fixations.