CAJ | 학술논문

目的探讨交锁髓内钉治疗股骨干骨折术后并发症的原因,并提出防治措施。方法对我院1994～1999年116例交锁髓内钉治疗股骨干骨折病人进行回顾分析，其中对14例延迟愈合者采取拔除锁钉，变静力固定为动力固定;对6例骨不连者，全部取钉、换钉并植骨;对4例骨感染者进行病灶清除加拔钉，适度的外固定。结果骨延迟愈合14例，随访1年全部愈合；骨不连6例，其中二次手术4例，三次手术2例，随访1年半均愈合；骨感染4例，3例愈合，1例未愈。总有效率95.8％。结论交锁髓内钉治疗股骨干骨折，虽比其他内固定具有较明显的优势，但产生骨延迟愈合、骨不连、骨感染、断钉等并发症并不少见。严格掌握手术指征、适当选材、适时掌握静力固定与动力固定、第二次手术扩髓与不扩髓、彻底清创与严格的无菌操作是减少并发症的有效措施。
목적탐토교쇄수내정치료고골간골절술후병발증적원인,병제출방치조시。방법대아원1994～1999년116례교쇄수내정치료고골간골절병인진행회고분석，기중대14례연지유합자채취발제쇄정，변정력고정위동력고정;대6례골불련자，전부취정、환정병식골;대4례골감염자진행병조청제가발정，괄도적외고정。결과골연지유합14례，수방1년전부유합；골불련6례，기중이차수술4례，삼차수술2례，수방1년반균유합；골감염4례，3례유합，1례미유。총유효솔95.8％。결론교쇄수내정치료고골간골절，수비기타내고정구유교명현적우세，단산생골연지유합、골불련、골감염、단정등병발증병불소견。엄격장악수술지정、괄당선재、괄시장악정력고정여동력고정、제이차수술확수여불확수、철저청창여엄격적무균조작시감소병발증적유효조시。
Objective　To investigate the causes and preventive methods of postoperative complications of femoral shaft fracture treated with intramedullary interlocking nails. 　Methods　A total of 116 patients with femoral shaft fractures admitted to our hospital from 1994 to 1999 were retrospectively studied in this article. They were all treated with intramedullary interlocking nails. The locking nails were removed from the 14 patients with delayed union to convert the fixation from static to dynamic. For the 6 patients with bone nonunion, the locking nails were removed, and new locking nails and bone grafts were employed. And for the 4 patients with bone infection, the foci were cleaned and the locking nails were removed, then certain external fixation was applied.　Results　Followed up for 1 year, the fractures of 14 patients with delayed union were completely healed. For the 6 patients with bone nonunion, reoperation was needed in 4 patients and a third operation needed in 2 patients, and they all healed after being followed up for one and half a year. For the 4 patients with bone infection, only 3 patients healed. The whole effective rate was 95.8%. 　Conclusions　Although the intramedullary interlocking nails used for femoral shaft fractures have advantages than other internal fixations, the complications of delayed healing, nonunion, bone infection and breaking nails are often found. The effective measures to reduce the complications include strict master of the operative indications, suitable materials for the implant and conversion of the fixation from static to dynamic in time, careful selection of debriding the realm or debriding no realm, complete debridement and strict abacterial procedures.