交锁髓内钉治疗股骨骨折并发症的处理及原因分析

[目的]探讨交锁髓内钉治疗股骨骨折术后并发症的发生原因和处理方法。[方法]本院1999年1月～2004年12月对243例股骨骨折行交锁髓内钉治疗，发生并发症14例，其中骨延迟愈合2例、骨不愈合3例、锁钉失败6例（锁钉松动退出4例，锁钉折弯1例，锁钉断钉1例）、主钉断钉伴骨不愈合1例、术后再骨折1例、膝关节僵直1例。2例骨延迟愈合及时改静力交锁为动力交锁；3例骨不愈合行植骨治疗；主钉断钉和再骨折行扩髓、换钉、植骨治疗；1例锁钉松动退出伴骨不愈合行换钉、植骨治疗；膝关节僵直行股四头肌成形术。[结果]14例患者经过对症治疗，骨延迟愈合、骨不愈合均骨愈合，膝关节功能恢复满意。[结论]交锁髓内钉治疗股骨骨折虽有一定并发症，比其他内固定具有较明显的优势。出现并发症后，及时采取正确有效的处理方法，能达到满意的效果。

Causes analysis and management of postoperative complications after femoral fractures treated with interlocking intramedullary nails

[Objective]To investigate the causes and treatment methods of postoperative complications of femoral fractures treated with interlocking intramedullary nails.[Method]A total of 243 cases of femoral fractures from Jan 1999 to Dec 2004 were treated with interlocking intramedullary nails.There were 14 cases having complications,delayed union in 1,nonunion in 3,nailing failure in 6(locking scerw loosen in 4,locking scerw folding in 1,locking scerw breakage in 2),nail breakage in 1,re-fracture in 1 and knee ankylosis in 1.Two cases with delayed union to convert the fixation from statictody namicin time;3 cases with nonunion were treated with bone grafting.Breakage nail and re-fractuer cases were treated with enlarging intramedullary tunels,exchanging nails and bone grafting.One of locking scerw loosen were treated with exchanging nails and bone grafting.Knee ankylosis were treated with quadriceps plasty.[Result]Through treatment,the delayed union and the nonunion were all healed and got recovery of knee function.[Conclusion]Though it has certain complications,the interlocking intramedullary nails used for femoral fractures have more advantages than other internal fixations.It needs to take valid measures to reach a satisfying result when complication appears.