扩髓带锁髓内钉治疗下肢长管状骨骨折不愈合

目的探讨扩髓带锁髓内钉治疗下肢长管状骨骨折不愈合的临床疗效。方法采用扩髓带锁髓内钉治疗下肢长管状骨骨折不愈合52例,其中股骨骨折36例,胫骨骨折16例。导致骨折不愈合的主要原因为内固定松动、断裂41例,占78．8％;骨缺损,骨感染、骨折过度牵引等所致11例,占21．2％。按照X线分型标准：肥大型41例,萎缩型11例。本组病例行切开复位,取出原固定物,清除硬化骨、死骨及瘢痕组织,顺行电动或手动扩髓,带锁髓内钉固定,骨折断端间隙及周围植骨。伴膝关节僵硬者,手法和手术相结合松解粘连。根据Judet膝关节活动度疗效评价标准对术后疗效进行评价。结果3例发生浅表感染,其中2例伤口延迟愈合,1例行清创、延期缝合后愈合外,其余49例切口一期愈合。随访时间12—39个月,平均25个月。所有病例均获骨性愈合,愈合时间5—11个月,平均6个月。无深部感染、脂肪栓塞、内固定物松动、断钉、骨折再不愈合等并发症。Judet膝关节活动度疗效评价标准,优良率82．7％。结论扩髓带锁髓内钉治疗下肢长管状骨骨折不愈合是一种有效方法。

Treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail

Objective To investigate the clinical effect of the treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail.Methods Fifty-two patients with ununited lower limb fracture were treated with intramedullary interlocking nail(femur 36,tibia 16).The main cause of nonunion was interternal fixation loosening or fracture(41 cases,78.8%),other reasons included bone defection,bone infection or too much traction of fracture(11 cases,21.2%).According to X-ray classification:41 cases in type hypertrophy,11 cases in type atrophy.All these patients need operation to remove the primary implant, clean the hard bone,ischemia bone and scar,manual ream and fix by intramedullary interlocking nail,then bone graft were done around the fracture site.With the knee joint stiffness,relax it by manipulate or operation.Results Beside 3 superficial infection(2 delayed healing and 1 healing after debridement), other 49 wounds healed on time.All cases were followed up for an average of 25.2 months,ranging from 12 months to 39 months.All the ununion healed from 5 to 11 months,mean union time were 6.1 months.Deep tissue infection,fat embolism,implant loosening,nail broken or nonunion were not found in this series. According to judet standard on the movement of knee,the excellent-good rate was 82.7%.Conclusions Intramedullary interlocking nail is effective to treat nonunion of lower limb fracture.