交锁髓内钉动力化治疗股骨干骨折延迟愈合

目的分析交锁髓内钉动力化治疗股骨干骨折延迟愈合的疗效。方法对21例股骨干骨折延迟愈合的患者采用交锁髓内钉动力化治疗(均为简单类型骨折,首次治疗均使用静力型交锁髓内钉),并随访骨折愈合情况、肢体长短和有无旋转畸形。结果21例中15例骨折愈合(71.4%),4例骨折不愈合(19.0%),2例发生交锁髓内钉断裂(9.5%),交锁髓内钉动力化治疗股骨干骨折愈合平均(5.6±1.9)月。初次手术切开治疗6例愈合4例(66.7%),闭合复位治疗15例愈合11例(73.3%),二者间差异无统计学意义(P>0.05)。距初次手术6个月内使用交锁髓内钉动力化治疗股骨干骨折的愈合率(86.7%)明显高于距初次手术6个月后动力化治疗的愈合率(33.3%),二者间差异有统计学意义(P<0.05)。股骨干骨折愈合患者股骨短缩平均(5.6±1.5)mm;交锁髓内钉动力化治疗后无旋转畸形。结论交锁髓内钉动力化治疗6个月内简单类型的股骨干骨折延迟愈合疗效满意。

Dynamization for delayed union of femoral shaft fracture treated with interlocking intramedullary nailing

Objective To investigate the clinical effects of dynamization for delayed union of femoral shaft fracture with interlocking intramedullary nailing.Methods The retrospective research was made on twenty-one cases of patients who had delayed union of femoral shaft fractures and had been primarily managed by static interlocking intramedullary nailing then treated by removing interlock screws.Fracture union,shortage and rotation deformity of femurs were observed.Results In all patients,fifteen cases achieved all unioned（71.4%）through average（5.6±1.9）months,but four cases achieved disunion（19.0%）,two cases suffered from nail broken（9.5%）.The union rate was not significantly different between patients with open reduction（4 in 6 cases,66.7%） and those with close reduction（11 in 15 cases,73.3%）（P〉0.05）.The union rate of dynamization within 6 months after primary internal fixation（13 in 15 cases,86.7%） was significantly higher than that of dynamization 6 months later（2 in 6 cases,33.3%）（P〈0.05）.The shortage of femurs ranged average（5.6±1.5）mm in patients with fracture healing,but no rotation deformity was found.Conclusion Selecting simple fractures and removing interlocking screws within 6 months,dynamization of interlocking intramedullary nailing could achieve satisfactory results for delayed union of femoral shaft fracture.