保留髓内钉附加侧板治疗股骨干非峡部段骨不连

背景：对于股骨干骨折髓内钉固定后干骺端骨不连患者，有报道称更换髓内钉是一种可选择的最佳治疗方法。然而，对于股骨干非峡部段骨折髓内钉固定后骨不连患者，其临床疗效并不理想。 目的：比较更换髓内钉与保留髓内钉附加侧板治疗股骨干非峡部段骨不连的临床与影像学结果。 方法：回顾性分析39例股骨干骨折髓内钉固定后非峡部段骨不连患者临床资料，其中更换髓内钉21例，保留髓内钉附加侧板18例。根据Tohner-Wrnch标准评定临床疗效。 结果与结论：所有患者均获得15个月以上随访。更换髓内钉组中，3例患者内固定后出现内固定松动，经再次行保留髓内钉、附加侧板并联合自体髂骨植骨治疗后顺利完成骨性愈合。保留髓内钉、附加侧板组内固定时间、出血量、输悬浮红细胞、住院费用、再手术率均显著低于更换髓内钉组（P〈0.05）。两组患者最终均获得骨性愈合,更换髓内钉组的临床及影像学愈合时间均显著长于保留髓内钉附加侧板组（P〈0.05）；末次随访时，根据Tohner-Wrnch标准评定疗效：更换髓内钉组：优10例，良6例，差5例，优良率76%；保留髓内钉附加侧板组：优11例，良7例，优良率100%，两组之间比较差异有显著性意义（P 〈0.05）。与更换髓内钉相比，应用保留髓内钉附加侧板及联合自体骨植骨治疗股骨干非峡部段骨不连，其操作相对简单、内固定时间短、内固定中出血少、创伤轻、住院费用少，再手术率低，且临床疗效满意，是一种可选择的更佳的治疗方法。

Intramedullary nail retention and augmentation plating for the treatment of nonisthmal femoral shaft nonunions

BACKGROUND：Exchange nailing has been reported to be a very good method for metaphyseal nonunion after femoral shaft fracture treated with intramedul ary nail. However, the effect of intramedul ary nail exchanging is not ideal for the treatment of nonisthmal femoral shaft nonunions.
OBJECTIVE： To compare the clinical and imaging outcomes between intramedul ary nail exchanging and intramedul ary nail retention plus augmentation plating for the treatment of nonisthmal femoral shaft nonunions.
METHODS：The clinical data of 39 patients with nonisthmal nonunions of femoral shaft fractures after failure of intramedul ary nail were retrospectively analyzed, and 21 patients were treated with intramedul ary nail exchanging and 18 patients were treated with intramedul ary nail retention plus augmentation plating. Clinical therapeutic effect was evaluated by Tohner-Wrnch standard.
RESULTS AND CONCLUSION：Al cases were fol owed-up for more than 15 months. In the intramedul ary nail exchanging group, postoperative internal fixator loosening occurred in three cases who obtained bony union by intramedul ary nail retention plus augmentation plating combined with autogenous iliac bone graft. The fixation time, blood loss, volume for suspended red blood cel s transfusion, hospitalization costs and re-operation rate in the intramedul ary nail retention plus augmentation plating group were lower than that in the intramedullary nail exchanging group （P〈0.05）. Al the patients in two groups obtained bony union, and the clinical and radiographic healing time in the intramedul ary nail exchanging group were longer than those in the intramedul ary nail retention plus augmentation plating group （P〈0.05）;according to Tohner-Wrnch standard at final fol ow-up, excel ent in 10 cases, good in six cases and poor in five cases in the intramedul ary nail exchanging group, and the excel ent and good rate was 76%;in the intramedul ary nail retention plus augmentation plating group, there were 11 cases of excel ent and seven cases of good, and the excel ent and good rate was 100%;there was significant difference between two groups （P〈0.05）. Due to relatively simpler manipulation, shorter fixation time, less intraoperative blood loss, slighter trauma, less hospitalization cost, lower re-operation rate and more satisfactory therapeutic effect, intramedul ary nail retention plus augmentation plating combined with autogenous iliac bone graft has been a better method for the treatment of nonisthmal nonunions of femoral shaft fractures after failure of intramedul ary nailing when compared with intramedul ary nail exchanging.