摘要
目的 :分析股骨骨折不愈合的原因 ,并评价交锁髓内钉治疗股骨不愈合的效果。方法 :1996年 6月- 2 0 0 3年 1月 35例股骨骨折不愈合中 ,6例采用股骨近端交锁髓内钉内固定 ,2 1例采用通用股骨交锁髓内钉 ,8例采用逆行交锁髓内钉 (GSH)进行治疗 ;31例行植骨 ,4例行单纯闭合扩髓未植骨 ;8例同时行膝关节粘连松解术。采用X线检查及膝关节KSS评分 (膝关节活动度、膝关节评分和膝关节功能评分 ) ,对疗效进行评价。结果 :随访 10～ 36月 ,平均 15 .5月 ,所有病例均获牢固骨性愈合 ,平均愈合时间为 6 .5月 ,未见畸形愈合、感染及再骨折发生。按膝关节KSS评分 ,随访时膝关节平均活动度 94°,较术前平均改善 30° ,膝关节平均评分 95分 ,优 2 5例 ,良 10例。膝关节功能平均评分 91分。结论 :股骨骨折不愈合的主要原因是内固定使用不当 ,内固定技术存在问题和骨缺损处理不当。使用交锁髓内钉治疗骨折不愈合具有固定可靠、便于膝关节早期功能等优点 ,但应联合行骨移植及膝关节粘连松解术 ,以促进骨折愈合 ,改善膝关节功能。
Objective:To analyse the cause of non-union in femur and assess the clinical outcomes of intramedullary interlocking nail. Methods: Between June 1996 and January 2003, 35 cases of non-union of femur were treated with intramedullay interlocking nail (IMN). There were 20 males and 15 females; the average age of patients was 34.2 years (range 24 to 46 years). At surgery, the failed implants were removed in all 15 cases, bone graft was performed in 18 cases, closed reaming was done in 2 case.8 patients also received knee adhesion release operation. The X-ray examination and KSS knee functional score were used to evaluate the results. Results: The average duration of follow-up was 15.5 months. All patients achieved solid bone union at an average of 6.5 months. There were no malunion, infection and refracture in this series.According to the KSS rating system, the average range of motion (ROM) was 94 degrees, increased by 30 degrees compared with the preoperation ROM. The average Knee score was 95 points. The excellent result was obtained in 16 case, good in 4 cases. The average Knee function score was 91 points, Conclusion:The main reasons for non-union were improper selection of the indications and use of implants. Intrameduallary interlocking nail is one of the effective alternatives for femur non-union treatment.It can provide a stable and reliable fixation which is of benefit for early functional exercise.Bone grafting and knee joint adhesion release should be considered in order to enhance the bone healing and improve the knee ROM and function.
出处
《广州医学院学报》
2004年第3期55-57,共3页
Academic Journal of Guangzhou Medical College
关键词
股骨
骨折
不愈合
髓内钉
femur
fracture
nonunion
intramedullary nail
