34例股骨交锁髓内钉术后骨折延迟愈合的临床分析

目的探讨为减少股骨交锁髓内钉术后发生骨折延迟愈合,手术中的要点、方法及术后预防措施。方法回顾我院34例应用交锁髓内钉、术中采用不同复位方法治疗股骨干骨折,分析术后骨折愈合及延迟愈合情况。结果34例经至少1-2年的随访,27例骨折一期愈合;7例骨折延迟愈合,其中5例锁钉动力化后骨折愈合;2例骨折不愈合。结论正确地选择髓内钉入点位置及把握干骺端松质骨骨道方向;小切口切开满意复位、严重粉碎性骨折尽可能闭合复位穿钉以保护血运;合理的早期髓内钉动力化;可有效地减少股骨交锁髓内钉术后骨折延迟愈合的发生。

Clinical Analysis of Delayed Union in 34 Patients with Femoral Fractures Treated by Interlocking Intramedullary Nail

Objective To discuss the key point and method of the operation and postoperative preventive measure which can decrease the incidence of delayed union in patients with femoral shaft fracture treated by interlocking intramedultary nail. Methods Between January 2002 and December 2006,34 cases with femoral shaft fractures were treated by femoral interlocking intramedullary nails and different reduction methods, and the materials of postoperative union and delayed union were analyzed retrospectively. Results A follow-up of 1 to 2 years showed that 27 cases were with bony unions,7 with delayed unions of which unions in 5 cases after dynamic fixation and nonunions in 2 cases. Conclusions It can decrease effectively delayed union of femoral fracture after the internal fixation of interlocking intramedullary nail through correct position of nailing, understanding the direction of bony routeway of diaphyseal cancellous bone, satisfactory reduction with small incision,protecting the blood circulation through closing reduction for comminuted fractures with interlocking intramedullary nail and early dynamic fixation rationally.