带锁髓内钉治疗陈旧性股骨干骨折并发症及防治

Treatment and Prevention of the Complications of the Old Femoral Shaft Fracture Using Interlocking Intramedullary Nail

目的 :探讨带锁髓内钉在治疗陈旧性股骨干骨折方面的适应证及可能出现的并发症 ,提出预防措施 ,为提高疗效提供依据。材料与方法 :回顾总结 1992年 5月～ 2 0 0 0年 5月应用带锁髓内钉治疗陈旧股骨骨折 5 4例病人 ,男性 46例 ,女性 8例 ,平均年龄 3 7.2岁。结果 :病人随访时间 13～ 3 7个月 ,平均 17.3个月 ,骨折全部愈合。并发症发生情况 :适应证选择不当造成术中骨折近端骨劈裂 3例 ,术后急性深部感染 2例 ,浅部感染 1例 ,迟发感染 2例 ,近端锁钉断裂 1例 ,远端锁钉断裂 3例 ,其中 2根锁钉均断裂 1例。远端锁钉退出 2例。结论 :(1)应用带锁髓内钉治疗陈旧股骨干骨折应严格掌握适应证 ;(2 )发生感染要保持引流通畅 ,待骨折愈合后 ,取出髓内钉彻底清创灌洗 ;(3 )熟练操作技术 ,术后适当延长负重时间。

Objective:To study the indications and the possible complications in the treatment of old femoral shaft fracture using the interlocked intramedullary nail and to provide the evidence for prevention and better effect. Method: A retrospective review of 54 patients using interlocked intramedullary nail for old femoral shaft fractures was carried out between May 1992 to May 2000. There were 46 in males and 8 in females with the mean age of 37.2 years old. The patients were followed up for 13～37 months with the mean time of 17.3 months. Result:All fractures healed. Complications:3 cases with proximal break caused by unsuitable indications, 2 with acute postoperative deep infection, 1 with superficial infection, 2 with late infection, 1 with proximal screw breakage, 3 with distal screw breakage and 2 with distal screw backing out. Conclusion:(1) Appropriate indications should be chosen as using interlocked intramedullary nail for old femoral shaft fractures. (2) Drainage should be kept well as infection occurred. Debridement and washing should be executed while the fracture was healed and the nail taken out. (3) Skill should be mastered well and the time of bearing weight should be delayed.