扩髓带锁髓内钉治疗股骨骨折不愈合24例报告

The role of reamed intramedullary interlocking nail in the treatment of femoral shaft nonunion in 24 patients

目的 评价扩髓带锁髓内钉治疗股骨骨折不愈合的临床疗效。方法 1998年9月～2001年12月对24例股骨骨折不愈合患者采用扩髓带锁髓内钉进行治疗,行开放复位、扩髓和植骨。采用X线检查及膝关节活动度对结果进行评价。结果 随访6～28个月,平均12.5个月,所有病例均骨性愈合,愈合时间12～28周,平均22周,无感染、脂肪栓塞综合征、再骨折及断钉等并发症发生。随访膝关节活动度优16例,良6例,可1例,差1例。结论 股骨骨折不愈合的主要原因为内固定方式选择及治疗不当,固定技术不完善。使用扩髓带锁髓内钉治疗股骨骨折不愈合,具有内固定可靠,便于膝关节早期功能锻炼等优点。同时粉碎颗粒状骨移植可促进骨折愈合,临床应用效果满意。

Objective To assess the clinical outcomes of reamed intramedullary interlocking nail for the treatment of femoral shaft non- union. Methods 24 cases of femoral shaft nonunion were treated with this method from Sept. 1998 to Dec. 2001. Open reduction, reaming and bone graft were performed in all 24 cases. The results were evaluated with the X - ray examination and the mobility of the knee. Results The follow - up was from 6 to 28 months, with the average of 12.5 months. All patients achieved bony union. The healing times varied from 12 to 28 weeks, averaged 22 weeks. Infection, fat embolism syndrome, refraction and breaking of nails did not occur. In the follow - up study, the loss of the angle of the flexion of knees included less than 15 degrees (excellent, 16 cases), from 20 to 30 degrees (good, 6 cases), from 30 to 70 degrees(fair, 1 case) and more than 70 degrees(poor, 1 case), respectively. Conclusions The primary causes of femoral shaft nonunion are incorrect selection of internal fixation, unsuitable treatment and ineffective technique of fixation. The usage of reamed intramedullary interlocking nail in the treatment of femoral shaft non - union has many advantages, including the firm internal fixation and convenient early excises of knees. Bone transplantation of comminuted particles could prompt the healing of fracture with satisfied clinical effects.