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股骨干骨折术后不愈合25例临床分析

【摘 要】 目的 总结股骨干骨折术后不愈合的原因及再手术方法。 方法 1999 年2 月－ 2007 年1 月，收治股骨干骨折术后不愈合患者25 例。男18 例，女7 例；年龄27 ～ 61 岁，平均42 岁。车祸伤14 例，坠落伤6 例，跌摔伤5 例。股骨干骨折部位：上段4 例，中段18 例，下段3 例。原固定方法：国产加压钢板内固定12 例，进口AO 加压钢板内固定4 例，髓内钉固定7 例，外固定架固定2 例。入院X 线片检查无连续骨痂，骨折线明显。骨折至本次手术时间8 ～ 16 个月。术中采用AO 股骨交锁髓内钉固定16 例，AO 加压钢板内固定7 例，AO 单管单臂架外固定2 例。 结果 患者术后切口均Ⅰ期愈合。25 例均获随访6 ～ 14 个月，平均9.4 个月。骨折愈合时间为4 ～ 12 个月，平均7.2 个月。根据Tohner-Wrnch 标准证定临床疗效；优14 例，良9 例，差2 例，优良率92%。 结论 采用恰当内固定方式、术中操作仔细、术后进行正确功能锻炼是治疗股骨干骨折术后不愈合的关键。

TREATMENT OF OLD FEMORAL NECK FRACTURE IN YOUNG AND MIDDLE-AGED PATIENTS WITH RECONSTRUCTING FEMORAL NECK

Objective To explore an ideal operative treatment to preserve the hi p joint for the old femoral neck fracture in young and middle-aged patients. Methods Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 19-55 years old (37.6 on average), were reconstructed with free il iac grafts and fixed by dynamic hi p screws (DHS) and/or canulated screws. Multi ple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. All the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 (49.6 onaverage) before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head (ONFH) was confirmed by MRI. The duration between initial injury and surgery was 1-21 months (8.6 months on average). Results No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. All 28 cases were followed up for 20-72 months (35.8 months on average). A total of 25 fractures healed within 4-8 months, with the heal ing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases (25%) developed ONFH confirmed by MRI within 18 months, and 5 cases (17.9%) developed femoral head collapse. The Harris score was 27-100 (82.7 on average). Leg length discrepancy was not observed and the gait was fairly normal. Conclusion The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture heal ing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.

骨折周围骨痂移植治疗骨不愈合

目的 观察用骨痂移植对骨折不愈合作用的临床疗效。方法 1995年1月～2003年12月共收治增生型骨折不愈合19例，采用骨痂移植加内固定或外固定治疗。其中男16例，女3例；年龄19～57岁。骨折部位：肱骨4例，尺桡骨2例，股骨8例，胫骨5例。均为增生型骨折端有大量骨痂形成，其中普通钢板固定松动变形10例，加压钢板松动2例，梅花针固定变形3例，带锁髓内钉断裂2例，普通钢板断裂2例。骨折不愈合时间8～24个月。结果 19例均获6～18个月随访，平均15.6个月。骨折愈合时间为6～8个月，其中1例术后7个月外伤后再骨折，钢板弯曲，经手术及骨痂骨植骨后7个月愈合。钢板内固定及交锁髓内钉治疗者无伤口感染；外固定架固定者1例针道感染，经消炎、换药痊愈。上肢骨折6例功能恢复良好；下肢骨折13例除上述1例再骨折功能恢复稍差外，其余功能恢复良好。结论 采用骨痂移植简便易行，骨折愈合率高，可作为一种治疗骨不愈合的骨移植材料。

高原地区交锁髓内钉治疗胫腓骨骨折骨不愈合

PRIMARY TREATMENT FOR CICATRIX, BONY DEFECT, AND SHORTENING OF THE LIMB

Six cases of old fracture of the tibia with large sear, bony defect, and shortening deformity of the limb were treated by elongation osteotomy at epiphysis and compression fixation of the fracture with external semilunar fixation frame. The bony defect ranged from 3cm to 6cm. Bony healing developed in all patients 4-7 months after operation. Early postoperative movement was suggested. The results revealed that there was an obvious improvement of the joint function and the shortened legs were corrected. The advantages of this method are that there is no need of bone grafting and operative treatment of the scar prior to treatment of the bone.