交锁髓内钉治疗长管状骨骨折不愈合及延迟愈合

Interlocking nail in the treatment of delayed union and non-union of long bone

目的 通过 32例长管状骨陈旧性骨折、骨折延迟愈合或不愈合病例治疗 ,探讨分析该组病例首次治疗失败的原因及再次手术的体会。方法 分析 32例患者本次手术前的X线片、局部情况及手术中情况 ,推断导致骨折不愈合及延迟愈合的可能情况。并使用扩髓后交锁髓内钉治疗 ,早期以静力型交锁 ,3～ 6个月后改动力型交锁 ,9例患者同时行植骨术 ,术后辅以循序渐进的康复训练。结果 随访 1 8～ 46个月 ,平均 2 7 5个月。骨折愈合率至术后 1 2个月达 81 2 5 % (2 6/32例 ) ,至术后 2 7 5个月达 96 88% (31 /32 ) ,至术后 43个月达 1 0 0 %。骨折愈合时间 8 3～ 43个月 ,平均 1 3 4个月 ,无严重并发症发生。结论 骨折早期正确处理与预后直接相关 ,交锁髓内钉是治疗长管骨骨折不愈合的较好选择。

Objective To analyse the reasons of failure on primary treatment and the experience of secondary operation on 32 patients with old fracture,delayed union and non union of long bones Methods The X ray film,local features,information during operation of 32 cases were analysed to find out the reason of delayed union or non union of 32 patients.Interlocking nail were used in secondary operation and dynamic interlocking was used later on after 3～6 months,9 patients had bone grafting at same time.Progressive exercises were continued post operatively.Results All of the patients were followed up for an average of 27 5 months (ranged 18 to 46 months).The fracture in 26 patients (81 25%) were healed up after 12 months and all of cases after 43 months.The average healing time was 13 4 months (ranged 8 3 to 43 months).No serious complication was encountered.Conclusion The interlocking intramedullary nail is more effective for the treatment of non union or delayed union of long bone fractures.Early timely management of the fracture is the key point for a satisfactory outcome.