交锁髓内钉动力化治疗股骨干骨折不愈合_Chinese Journal of Reparative and Reconstructive Surgery

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程坚 ¹ , 符培亮 ² , 陶波 ¹

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Keywords：

髓内钉; 股骨干骨折; 动力化固定

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目的总结交锁髓内钉动力化固定对骨折愈合的影响，分析动力化固定后可达到正常愈合的类型。方法回顾性分析2005年6月－2010年8月30例初始行静力锁定后再行动力化固定患者临床资料。男25例，女5例；年龄18～60岁，平均34岁。股骨干骨折26例，转子下骨折4例。均为闭合损伤。根据AO分型：A1型2例，A2型2例，A3型1例，B1型5例，B2型6例，B3型2例，C1型8例，C2型4例。根据骨折或不愈合端的力学稳定性和生物活性分型：稳定/增生型8例、稳定/萎缩型5例、不稳定/增生型9例、不稳定/萎缩型8例。于初次静力钉术后6～18周，平均14周后行髓内钉动力化固定。结果术后患者切口均Ⅰ期愈合。30例均获随访，随访时间6～18个月，平均12个月。24例骨折于动力化固定后3～6个月完全愈合，4例于7～11个月延迟愈合，2例不愈合。3例不稳定/萎缩型患者出现明显股骨短缩，1例不稳定/萎缩型患者出现旋转移位。结论髓内钉动力化治疗股骨干骨折不愈合疗效确切，但不稳定/萎缩型患者行动力化固定术后并发症较多。

Citation： 程坚,符培亮,陶波. 交锁髓内钉动力化治疗股骨干骨折不愈合. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 125-126. doi: Copy

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1. Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing: its application to comminuted fractures of the femur. J Bone Joint Surg (Am), 1985, 67(5): 709-720.
2. Egger EL, Gottsauner-Wolf F, Palmer J, et al. Effects of axial dynamization on bone healing. J Trauma, 1993, 34(2): 185-192.
3. Larsson S, Kim W, Caja VL, et al. Effect of early axial dynamization on tibial bone healing. Clin Orthop Relat Res, 2001, (388): 240-251.
4. Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
5. Papakostidis C, Psyllakis I, Vardakas D, et al. Femoral-shaft fractures and nonunions treated with intramedullary nails: the role of dynamisation. Injury, 2011, 42(11): 1353-1361.
6. Basumallick MN, Bandopadhyay A. Effect of dynamization in open interlocking nailing of femoral fractures. A prospective randomized comparative study of 50 cases with a 2-year follow-up. Acta Orthop Belg, 2002, 68(1): 42-48.
7. Tigani D, Fravisini M, Stagni C, et al. Interlocking nail for femoral shaft fractures: is dynamization always necessary? Int Orthop, 2005, 29(2): 101-104.
8. Richmond J, Colleran K, Borens O, et al. Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma, 2004, 18(9): 603-610.
9. 潘垚, 安智全, 曾炳芳. 交锁髓内钉早期动力化治疗胫骨干骨折. 中华创伤骨科杂志, 2006, 8(8): 734-736.
10. Fadero PE, Alabi S, Adebule GT, et al. Locked intramedullary nailing for the treatment of femoral shaft fractures: experience and result in 19 cases. Niger J Med, 2008, 17(2): 168-172.

Chinese Journal of Reparative and Reconstructive Surgery

交锁髓内钉动力化治疗股骨干骨折不愈合

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