股骨干骨折髓内钉固定动力化后骨不连原因分析

Analysis of the causes of bone nonunion after the dynamization of the femoral shaft fracture treated with interlocking intramedullary nailing

目的探讨股骨干骨折交锁髓内钉固定动力化后骨不连的原因,并提出防治措施。方法回顾性分析2004年1月-2014年12月收治的27例股骨干髓内钉固定动力化后骨不连的临床资料,对股骨干骨折部位、动力化适应证、动力化时机等因素进行综合分析,研究导致股骨干骨折髓内钉固定动力化后骨不连的原因。结果Ⅰ期使用动力性固定致使骨折断端不稳导致骨不连5例;静-动力型固定转换不合理17例;动力化后过早负重行走导致髓钉断裂2例;髓内钉适应证选择或操作不当,动力化后骨折断端更加不稳定,导致骨不愈合3例。结论尽管很少有客观的证据来支持动力化的疗效,但相对于其他的侵入性大的手术来说,这种手术的风险和费用相对较小,所以,对于力线好、没有缺损的股骨干峡部以外的横断及短斜形骨折,动力化仍是一个可行的选择。但要严格掌握适应证并对患者的负重进行相应的限制。

Objective To discuss the causes of bone nonunion after the dynamization of the femoral shaft fracture treated with intramedullary interlocking nail and put forward the prevention and treatment measures. Methods Retrospective analysis of 27 patients of bone nonunion after the dynamization of the femoral shaft fracture treated with intramedulIary interlocking nail from January 2004 to December 2014 in The 252nd Hospital of PLA. Comprehensive analysis of the fracture site of femoral shaft, dynamic adaptation and dynamic time. to study the cause of bone nonunion after the dynamization of the femoral shaft fracture treated with intramedullary interlocking nail. Results Five patients of bone nonunion were caused by unstable fracture end with dynamic fixation in the first stage. 17 patients of static and dynamic fixed conversion were not reasonable. 2 patients of fatigue fragmentation were caused by prematurely walking. Improper selection of intramedullary nail Indication. The broken end of fracture was more unstable after the dynamics of the intramedullary nail, which resulted in 3 patients of bone nonunion. Conclusion Although the effect of little objective evidence to support dynamic, but compared to other large invasive surgery, the risk and cost of this operation is relatively small. For the transverse and short oblique fracture outside the dry femoral isthmus without bone defect, dynamization is still a viable option. But it is necessary to have strict indications and limit the weight of the patient.