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股骨干骨折術后不愈合25例臨床分析

【摘 要】 目的 總結股骨干骨折術后不愈合的原因及再手術方法。 方法 1999 年2 月－ 2007 年1 月，收治股骨干骨折術后不愈合患者25 例。男18 例，女7 例；年齡27 ～ 61 歲，平均42 歲。車禍傷14 例，墜落傷6 例，跌摔傷5 例。股骨干骨折部位：上段4 例，中段18 例，下段3 例。原固定方法：國產加壓鋼板內固定12 例，進口AO 加壓鋼板內固定4 例，髓內釘固定7 例，外固定架固定2 例。入院X 線片檢查無連續骨痂，骨折線明顯。骨折至本次手術時間8 ～ 16 個月。術中采用AO 股骨交鎖髓內釘固定16 例，AO 加壓鋼板內固定7 例，AO 單管單臂架外固定2 例。 結果 患者術后切口均Ⅰ期愈合。25 例均獲隨訪6 ～ 14 個月，平均9.4 個月。骨折愈合時間為4 ～ 12 個月，平均7.2 個月。根據Tohner-Wrnch 標準證定臨床療效；優14 例，良9 例，差2 例，優良率92%。 結論 采用恰當內固定方式、術中操作仔細、術后進行正確功能鍛煉是治療股骨干骨折術后不愈合的關鍵。

骨折周圍骨痂移植治療骨不愈合

目的 觀察用骨痂移植對骨折不愈合作用的臨床療效。方法 1995年1月～2003年12月共收治增生型骨折不愈合19例，采用骨痂移植加內固定或外固定治療。其中男16例，女3例；年齡19～57歲。骨折部位：肱骨4例，尺橈骨2例，股骨8例，脛骨5例。均為增生型骨折端有大量骨痂形成，其中普通鋼板固定松動變形10例，加壓鋼板松動2例，梅花針固定變形3例，帶鎖髓內釘斷裂2例，普通鋼板斷裂2例。骨折不愈合時間8～24個月。結果 19例均獲6～18個月隨訪，平均15.6個月。骨折愈合時間為6～8個月，其中1例術后7個月外傷后再骨折，鋼板彎曲，經手術及骨痂骨植骨后7個月愈合。鋼板內固定及交鎖髓內釘治療者無傷口感染；外固定架固定者1例針道感染，經消炎、換藥痊愈。上肢骨折6例功能恢復良好；下肢骨折13例除上述1例再骨折功能恢復稍差外，其余功能恢復良好。結論 采用骨痂移植簡便易行，骨折愈合率高，可作為一種治療骨不愈合的骨移植材料。

高原地區交鎖髓內釘治療脛腓骨骨折骨不愈合

TREATMENT OF OLD FEMORAL NECK FRACTURE IN YOUNG AND MIDDLE-AGED PATIENTS WITH RECONSTRUCTING FEMORAL NECK

Objective To explore an ideal operative treatment to preserve the hi p joint for the old femoral neck fracture in young and middle-aged patients. Methods Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 19-55 years old (37.6 on average), were reconstructed with free il iac grafts and fixed by dynamic hi p screws (DHS) and/or canulated screws. Multi ple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. All the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 (49.6 onaverage) before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head (ONFH) was confirmed by MRI. The duration between initial injury and surgery was 1-21 months (8.6 months on average). Results No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. All 28 cases were followed up for 20-72 months (35.8 months on average). A total of 25 fractures healed within 4-8 months, with the heal ing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases (25%) developed ONFH confirmed by MRI within 18 months, and 5 cases (17.9%) developed femoral head collapse. The Harris score was 27-100 (82.7 on average). Leg length discrepancy was not observed and the gait was fairly normal. Conclusion The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture heal ing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.

PRIMARY TREATMENT FOR CICATRIX, BONY DEFECT, AND SHORTENING OF THE LIMB

Six cases of old fracture of the tibia with large sear, bony defect, and shortening deformity of the limb were treated by elongation osteotomy at epiphysis and compression fixation of the fracture with external semilunar fixation frame. The bony defect ranged from 3cm to 6cm. Bony healing developed in all patients 4-7 months after operation. Early postoperative movement was suggested. The results revealed that there was an obvious improvement of the joint function and the shortened legs were corrected. The advantages of this method are that there is no need of bone grafting and operative treatment of the scar prior to treatment of the bone.