股骨干骨折术后内固定失效原因分析

目的探讨股骨干骨折术后内固定失效的原因,以利于更好地指导临床治疗。方法股骨干骨折内固定失效后均出现骨不连,其中肥大型骨不连12例,萎缩型骨不连4例,感染性骨不连2例。1例取出内固定,选择单髋石膏外固定;2例感染性骨不连采用AO外固定架固定;15例更换髓内钉固定。结果本组手术时间60~160 min,平均90 min;术中输红细胞400~600 ml,平均440 ml。18例均获得随访14~26个月,平均18个月。末次随访时采用膝关节功能HSS评分评定疗效：优10例,良6例,可1例,差1例。疗效差的1例因反复感染,骨折仍未愈合。结论股骨干骨折术后内固定失效的原因：1内固定选择失误或钢板未放置张力侧;2骨折合并骨缺损,未一期植骨;3骨折部位血液循环损伤严重导致骨折愈合时间延长,进而内固定疲劳失效;4术后早期负重或不恰当的功能锻炼。

Analysis of reasons following femoral fracture internal fixation failure

Objective To investigate the femoral fracture intemal fixation failure reasons, and help to better guide clinical treatment. Methods The reasons of bone nonunion following internal fixation failure were analysed, included 12 eases of hypertrophic bone nonunion, 4 cases of atrophic bone nonunion, 2 eases of infectious bone nonunion. One ease received removal of internal fixator and single hip plaster external fixation; 2 cases of infective bone nonunion underwent AO external fixator fixation; 15 cases were treated with replacement of intramedullary nail fLxation. Results The operation time ranged from 60 to 160 rain, with an average of 90 min. Intraoperative loss of red blood cells was 400-600 ml, with an average of 440 ml. Eighteen eases received follow-up of 14 to 26 months, with an average of 18 months. HSS knee joint function was used at last follow-up for rating efficacy： excellent in 10 cases, good in 6 cases, fair in 1 case, and poor in 1 ease. The fracture of the poor ease with repeated infection did not have healing. Conclusion The femoral fracture internal fixation failure reasons are as follows： （1）wrong selection of internal fixation or plate was not placed on the tension side; （2）fraeture combined with bone defect, no bone grafting was performed;（3）fracture blood circulation badly damaged lead to prolonged fracture healing time, and failure due to internal fixation fatigue; （4）early postoperative weight-bearing or inappropriate functional exercise was found.