股骨骨折骨不连的生物力学因素及其对策

目的：探讨股骨骨折骨不连的生物力学因素，并提出相应的对策。方法：68例股骨干骨折骨不连经带锁髓内钉治疗，13例股骨远端骨折骨不连实施动力髁螺钉(DCS)内固定术，治疗同时行自体髂骨髓腔内外植骨术。结果：81例股骨骨折骨不连患者随访8～24个月，平均14个月。68例股骨干骨不连治疗后，有5例出现主钉或锁钉折断，经再次行带锁髓内钉内固定加植骨术治愈，其余患者不连端全部愈合；13例股骨远端骨不连经DCS内固定术后全部愈合。81例平均愈合时间为6．5个月。根据骨折愈合及功能恢复综合指标评定疗效，本组优54例，良21例，差6例，优良率92．6％。结论：股骨骨折骨不连的主要原因为内收肌群的生物力学因素导致内固定失败造成；股骨干骨折及骨不连手术内固定应以髓内固定为主，股骨髁部骨折及不连接应选用坚强的DCS系统。

Biomechanical factors in and countermeasures for nonunion of femoral fractures

Objective To discuss the biomechanical factors in the nonunion of femoral fractures and raise corresponding measures. Methods Sixty eight cases with nonunion of femoral shaft fractures were treated with interlocking intramedullary nailing and 13 with nonunion of distal femoral fractures fixated with dynamic condylar screw (DCS). Inner and outer intramedullary bone graft was performed simultaneously. Results The follow up time was 8 24 months with an average of 14 months in all cases. Sixty eight cases got bone healing except for five cases with breakage of nail or lock nail, which were all cured with again interlocking intramedullary nailing combined with bone graft. Thirteen cases with nonunion of distal femoral fractures were healed after DCS internal fixation treatment. The healing time averaged 6.5 months in 81 cases. According to synthetic standards including bone healing and function recovery, 54 cases won excellent bone healing, 21 good and 6 poor, with an excellence rate of 92.6%. Conclusions The failed femoral fracture operation is mainly due to the failed internal fixation caused by the biomechanical factor of the abductor muscles. Therefore, intramedullary nailing system should be the first choice for internal fixation of femoral shaft fractures and nonunion; and DCS should be used for condylar fractures and nonunion.