顺行加压交锁髓内钉与记忆接骨器治疗股骨下段骨不连

目的探讨顺行加压交锁髓内钉结合天鹅记忆接骨器(SMC)治疗股骨远端骨不连的临床疗效。方法18例股骨远端骨不连患者,采用顺行加压交锁髓内钉与SMC相结合内固定,确保不连端的牢稳固定,并利用SMC的植骨优势作用。植骨采用自体髂骨,骨移植形式为加垫法、夹板法、播种法相结合,充分发挥移植骨的骨诱导与骨传导作用,术后短期行CPM训练膝关节功能。结果所有患者随访12～48个月,平均18个月。18例全部获得骨性愈合,愈合时间3～6个月,平均4.8个月。术后膝关节活动范围由术前的平均84°(30°～135°)增加到101°(75°～135°)。按Shelbourne疗效评定标准,优良率88.9%。结论利用顺行加压交锁髓内钉与SMC,并结合良好的自体髂骨移植技术,是治疗股骨下段骨不连的有效方法之一。

Treatment of nonunion of femoral inferior segment by antegrade compressive interlocking intramedullary nail and memory connector

Objective To analyze by a retrospective study of the treatment of nonunion of femoral inferior segment with antegrade compression interlocking nails combined with swan like memory connector (SMC). Methods 18 patients with nonunion of femoral inferior segment were treated with open reduction and internal fixation. The nonunion was fixed with antegrade compression interlocking nails and SMC to provide rigid fixation and the advantage of bone grafting of SMC. Iliac autografts were used. The nonunion space was padded with iliac blocks or spanned by iliac grafts just like splints, and the spatium between SMC and bone was filled with scum of spongy bone, in order to fully arouse the inductive and conductive effects of the graft. Continuous passive motion was advised shortly after operation. The average time from the surgery to the latest followed up was 18 months (ranging from 12 to 48 months). Results By the time of the latest follow up examination, all 18 cases of nonunion had healed. The average time was 5 months (3 to 6 months). The arc of knee motion improved from 84 degrees preoperatively (30 to 135 degrees) to 101 degrees postoperatively (75 to 135 degrees). According to the Shelbourne knee rating system, excellent and good results were achieved in 16 cases (88.9%). Conclusion Antegrade compression interlocking nails and SMC, combined with iliac autograft, can provide an efficacious technique for treatment of nonunion of femoral inferior segment.