吻合血管腓骨髓腔内移植记忆合金环抱接骨器固定治疗老年人股骨干骨折不愈合

目的:探讨采用吻合血管腓骨髓腔内移植镍钛记忆合金环抱接骨器固定治疗老年股骨干骨折不愈合技术和疗效。方法:老年股骨干骨折不愈合17例,男13例,女4例;年龄63~79岁,平均(70·94±4·12)岁。其中合并短缩畸形12例,短缩伴成角畸形5例;短缩范围2·4~4·8cm,平均3·56cm;成角范围7°~13°,平均11°。切取适当长度的带血管蒂游离腓骨,去除两端的部分骨皮质,扩大骨不连处两断端的髓腔,将腓骨段两端分别插入股骨两断端的髓腔,将血管蒂断端与附近血管吻合,用镍钛记忆合金环抱接骨器固定。结果:17例8~12周便有良好的愈合,平均临床愈合时间9·8周。行走、负重等功能良好,无一例发生不愈合。功能评价结果:优14例,良3例。结论:吻合血管腓骨髓腔内移植镍钛记忆合金环抱接骨器固定术在坚强内固定的基础上植入有血运的腓骨,可加速愈合,早期恢复功能,是治疗老年人股骨干骨折不愈合的理想方法。

Treatment of non-union of femoral fracture in aged patients by transplantation of vascularized fibula into medullary cavity with Ni-Ti-shaped memory alloy of embracing internal fixator

Objective:To investigate the technique and outcome of the combination of vascularized fibula transplanted into medullary cavity and Ni-Ti-shaped memory alloy embracing internal fixator in treating aged patients with non-union of femoral fracture.Methods:Seventeen aged patients(13 male and 4 female with average age of 70.94±4.12 years) with non-union of femoral fracture were recruited,of which 12 cases had short deformity(average 3.56 cm)and 5 cases had angled deformity(average 11°).A suitable length of vascularized fibula with the cortex removed at both ends was inserted into the enlarged medullary cavity of the non-union femur.The blood vessels were anastomosed with the nearby vessels.The Ni-Ti-shaped memory alloy of embracing internal fixator was used.Results:The time for bone healing in 17 patients was 8 to 12 weeks(mean 9.8 weeks).No any case occurred with non-union postoperatively.All the patients exhibited a good function in walking and burdening.According to the standard for evaluating the curative effect,a excellent result was reached in 14 cases and good one in 3 cases.Conclusion:The vascularized fibula which was transplanted into medullary cavity in combination with the fixation by use of Ni-Ti-shaped memory alloy of embracing internal fixator can facilitate the clinical heal and functional recovery.This combined therapeutic method is an ideal approach in treating aged patients with femur non-union.