附加钢板治疗髓内钉新固定后股骨肥大性骨不连.doc

附加钢板治疗髓内钉固定后股骨肥大性骨不连 张建政 刘智 孙天胜 李京生 任继鑫 刘树清 胥少汀 [摘要] 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 1998年4月～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，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5 mm，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5 mm，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例取髂骨植骨和附加钢板固定手术时间共60～120 min，出血量100～300 ml。3例单纯附加钢板手术时间40～100 min，出血量60～100 ml。供骨区疼痛4例，3例1月内缓解，1例3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。 【关键词】 股骨骨折；髓内钉；固定；骨不连；附加钢板 Augmentative Plate Fixation to Treat Femoral Hypertrophic Nonunions Subsequent to Intramedullary Nailing ZHANG Jian-zheng, LlU Zhi, SUN Tian-sheng, et at. Department of Orthopaedics, General Hospital of Beijing Military Command, Beijing 100700, China [Abstract] Objective To investigate the effect of augmentative plate fixation to increase stability in treatment of femoral shaft nonunions subsequent to intramedullary fixation. Methods Nine femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation from April 1998 to Jane 2008, which were managed with a locked nail internal fixation. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all cases during operation. Leaving the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of the bone shaft. In all patients, there was visible motion at the fracture site，however, the motion disappeared after plate augmentation. Results All patients achieved radiological solid union at an average of 8 months (range, 6 to 11 months ). Their hardware was removed in 6 to 11 months after operation