摘要
目的 分析延迟动力化固定治疗交锁髓内钉固定后股骨干骨折不愈合的疗效和适应证。方法 2006年3月-2012年6月,采用延迟动力化固定治疗交锁髓内钉固定后股骨干骨折不愈合26例。男19例,女7例;年龄22～46岁,平均38岁。骨折后均行切开复位、顺行交锁髓内钉固定术,术后10～29个月,平均16个月。确诊为骨折不愈合。按Papakostidis等对骨折不愈合的分型标准：稳定/增生型7例,稳定/萎缩型3例,不稳定/增生型12例,不稳定/萎缩型4例。结果 患者术后切口均Ⅰ期愈合。26例均获随访,随访时间10～28个月,平均14个月。共16例（61.5%）于动力化固定后4～11个月骨折愈合（7例稳定/增生型）和9例不稳定/增生型;余10例（38.5%）治疗失败。延迟动力化固定后稳定/增生型骨折不愈合的愈合率为100%（7/7）,不稳定/增生型为75%（9/12）,稳定/萎缩型和不稳定/萎缩型均为0。结论 延迟动力化固定是治疗交锁髓内钉固定后股骨干增生型骨折不愈合的有效方法,不适用于股骨干萎缩型骨折不愈合的治疗。
Objective To investigate the effectiveness and indications of deferred dynamization for nonunion of femoral shaft fractures after static interlocking nail. Methods Between March 2006 and June 2012, 26 patients with nonunion of femoral shaft fractures after static interlocking nail were treated with deferred dynamization, and their data were analyzed retrospectively. There were 19 males and 7 females with a mean age of 38 years （range, 22-46 years）. Nonunion was found at 10- 29 months （mean, 16 months） after open reduction and static interlocking nail for fracture fixation. Referring to Papakostidis criteria for nonunion, there were 7 cases of stable/hyperplastic type, 3 cases of stable/atrophic type, 12 cases of unstable/ hyperplastic type, and 4 cases of unstable/atrophic type. Results All incision healed at first stage. Twenty-six patients were followed up 10-28 months （mean, 14 months）. A total of 16 （61.5%） fractures healed at 4-11 months after deferred dynamization （7 cases of stable/hyperplastic type and 9 cases of unstable/hyperplastic type）; the other 10 fractures failed to heal. The healing rate was 100% （7/7） in patients with stable/hyperplastic type nonunion, 75% （9/12） in patients with unstable/hyperplastic type nonunion, and 0 in patients with stable/atrophic type and unstable/atrophic type nonunion. Conclusion Deferred dynamization is an effective method for hyperplastic nonunion of femoral shaft fractures after static interlocking nail, but it is not suitable for atrophic nonunion of femoral shaft fractures.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第4期419-422,共4页
Chinese Journal of Reparative and Reconstructive Surgery
