附加钢板治疗髓内钉固定后股骨肥大性骨不连

目的:探讨附加钢板治疗髓内钉固定后股骨肥大性骨不连的安全性和有效性。方法:自1998年4月至2008年6月,应用附加钢板治疗9例髓内钉固定后股骨肥大性骨不连,男8例,女1例;年龄21～54岁,平均32岁。1例为股骨上1/3,5例为股骨中1/3,3例为股骨下1/3。采用4～6孔钛合金限制接触性窄动力接骨板,4～6枚皮质骨螺钉固定。6例骨不连间隙大于5mm,4例采用单纯髂骨植骨,2例固骼生和髂骨混合植骨。3例小于5mm,1例植入固骼生,2例将修整的骨痂重新植入。术后保护性负重防止主钉断裂失效,逐渐恢复术前活动水平,术后1、3、6、12个月临床与影像学随诊。结果:6例取髂骨植骨或固骼生混合植骨患者,手术时间60～120min,出血量100～300ml;另3例单纯植入固骼生或骨痂植入患者,手术时间40～100min,出血量60～100ml。供骨区疼痛4例,3例1个月内缓解,1例3个月后缓解,无感染、钢板螺钉松动、断裂等。平均愈合时间8个月,5例术后6～11个月取出髓内钉和钢板。结论:附加钢板有效改善局部旋转不稳定,是治疗髓内钉固定后股骨肥大性骨不连的有效方法之一。

Augmentative plate fixation for the treatment of femoral hypertrophic nonunions subsequent to intramedullary nailing fixtion

Objective: To investigate the effect of augmentative plate fixation to increase stability in the treatment of femoral shaft nonunions subsequent to intramedullary fixation. Methods: Nine patients with femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation from April 1998 to Jane 2008,included 8 males and 1 female,with an average age of 32 years old ranging from 21 to 54 years. One case was upper 1/3 femoral fractures,5 cases were middle 1/3 femoral fractures,3 cases were lower 1/3 femoral fractures. The interspace of bone nonunion was more than 5 mm in 6 cases,of them,iliac bone grafting were applied in 4 cases,artificial bone combined with iliac bone grafting were applied in 2 cases; The interspace of bone nonunion was less than 5 mm in other 3 cases,artificial bone grafting was applied in 1 case,fitting bone callus were applied in 2 cases. All patients got protected weight loading preventing the main screw break. Results: All patients achieved radiological solid union at an average of 8 months(ranged 6 to 11 months ). The fixation was removed during 6 to 11 months after operation in 5 cases. Donor site pain of iliac occurrenced on 4 cases,3 cases relieved 1 month later and 1 case relieved 3 months later. No infection,fixation loosening or breaking was observed. Conclusion: The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. The technique is simple and does not require any special instrument,which facilitates an early weight bearing and gives a quick recovery from nonunion.