CAJ | 학술논문

目的探讨更换髓内钉与保留髓内钉附加钢板治疗髓内钉固定后股骨肥大性骨不连的手术适应证。方法 1998年4月至2009年6月收治髓内钉固定后股骨肥大性骨不连患者20例，11例更换髓内钉，9例保留髓内钉附加钢板固定。两组患者性别、年龄、合并伤、骨折部位、骨折类型的差异无统计学意义。通过术后1、2、3、4、6、12个月及以后每年1次影像学和临床功能随访，观察骨痂生长情况和患肢功能。结果两组随访时间、手术时间、术中出血量、术后引流血量、住院时间、影像学愈合时间、临床愈合时间和美国矫形外科医师学会下肢功能评分均无统计学差异。更换髓内钉组住院费用多于保留髓内钉附加钢板组(t′=16.4，P=0.0 13)。更换髓内钉组4例未获得骨性愈合，其中2例为股骨下1/3骨折，1例为狭部B型骨折，1例为32-A3型骨折。再次手术，其中3例采用髂骨植骨保留髓内钉附加钢板固定，1例行动力化。保留髓内钉附加钢板组全部获得骨性愈合。两组愈合率的差异有统计学意义(χ2=6.01，P=0.008)。结论更换髓内钉只适用于股骨狭部肥大性骨不连。对干骺端骨不连、伴有大蝶形游离骨块、骨缺损及更换髓内钉失败病例可采用保留髓内钉附加钢板固定。
목적탐토경환수내정여보류수내정부가강판치료수내정고정후고골비대성골불련적수술괄응증。방법 1998년4월지2009년6월수치수내정고정후고골비대성골불련환자20례，11례경환수내정，9례보류수내정부가강판고정。량조환자성별、년령、합병상、골절부위、골절류형적차이무통계학의의。통과술후1、2、3、4、6、12개월급이후매년1차영상학화림상공능수방，관찰골가생장정황화환지공능。결과량조수방시간、수술시간、술중출혈량、술후인류혈량、주원시간、영상학유합시간、림상유합시간화미국교형외과의사학회하지공능평분균무통계학차이。경환수내정조주원비용다우보류수내정부가강판조(t′=16.4，P=0.0 13)。경환수내정조4례미획득골성유합，기중2례위고골하1/3골절，1례위협부B형골절，1례위32-A3형골절。재차수술，기중3례채용가골식골보류수내정부가강판고정，1례행동력화。보류수내정부가강판조전부획득골성유합。량조유합솔적차이유통계학의의(χ2=6.01，P=0.008)。결론경환수내정지괄용우고골협부비대성골불련。대간후단골불련、반유대접형유리골괴、골결손급경환수내정실패병례가채용보류수내정부가강판고정。
Objective To compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. Methods From April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. Results An unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group (t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). Conclusion EN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.