中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
11期
964-967
,共4页
毛玉江%武长江%孙林%朱仕文%王满宜
毛玉江%武長江%孫林%硃仕文%王滿宜
모옥강%무장강%손림%주사문%왕만의
股骨骨折%骨折,不愈合%骨折固定术,内%骨钉%手术方法
股骨骨摺%骨摺,不愈閤%骨摺固定術,內%骨釘%手術方法
고골골절%골절,불유합%골절고정술,내%골정%수술방법
Femoral fractures%Fractures,nonunited%Fracture fixation,internal%Bone nails%Surgical techniques
目的 介绍一种针对股骨干骨折不愈合伴钢板内固定失效后行再次髓内固定的改良手术技术. 方法 2006年1月至2009年12月共收治8例股骨干骨折钢板内固定失效患者,男7例,女1例；平均年龄为41.1岁(19 ～61岁).7例患者钢板断裂,1例患者钢板未断但螺钉拔出,骨折均未获愈合.首次手术至钢板失效接受本次手术时间平均为12.4个月(4～30个月).手术步骤:①X线机透视下经皮闭合取出所有螺钉,留置钢板；②同侧或对侧髂骨取骨,此步骤可由另一组手术人员与步骤①同时进行；③置入髓内钉；④切开骨折端,取出钢板,确认对位良好,清理瘢痕组织并植骨；⑤髓内钉远端锁定.5例患者采用顺行髓内钉固定,2例采用逆行髓内钉固定,1例采用股骨近端髓内钉固定. 结果 8例患者均顺利完成更换髓内钉固定手术,手术时间平均为2.6 h(2.0～3.5 h),术中失血量平均为1100 mL(600 ～ 1500 mL).术后1年随访8例患者骨折均获愈合,愈合时间平均为5.5个月(4～8个月),无感染等其他并发症发生. 结论 本文所介绍的改良手术技术可减少股骨干骨折不愈合伴钢板内固定失效后行再次髓内固定的手术失血量,其技术难点为经皮闭合取钉及硬化髓腔的再通.
目的 介紹一種針對股骨榦骨摺不愈閤伴鋼闆內固定失效後行再次髓內固定的改良手術技術. 方法 2006年1月至2009年12月共收治8例股骨榦骨摺鋼闆內固定失效患者,男7例,女1例；平均年齡為41.1歲(19 ～61歲).7例患者鋼闆斷裂,1例患者鋼闆未斷但螺釘拔齣,骨摺均未穫愈閤.首次手術至鋼闆失效接受本次手術時間平均為12.4箇月(4～30箇月).手術步驟:①X線機透視下經皮閉閤取齣所有螺釘,留置鋼闆；②同側或對側髂骨取骨,此步驟可由另一組手術人員與步驟①同時進行；③置入髓內釘；④切開骨摺耑,取齣鋼闆,確認對位良好,清理瘢痕組織併植骨；⑤髓內釘遠耑鎖定.5例患者採用順行髓內釘固定,2例採用逆行髓內釘固定,1例採用股骨近耑髓內釘固定. 結果 8例患者均順利完成更換髓內釘固定手術,手術時間平均為2.6 h(2.0～3.5 h),術中失血量平均為1100 mL(600 ～ 1500 mL).術後1年隨訪8例患者骨摺均穫愈閤,愈閤時間平均為5.5箇月(4～8箇月),無感染等其他併髮癥髮生. 結論 本文所介紹的改良手術技術可減少股骨榦骨摺不愈閤伴鋼闆內固定失效後行再次髓內固定的手術失血量,其技術難點為經皮閉閤取釘及硬化髓腔的再通.
목적 개소일충침대고골간골절불유합반강판내고정실효후행재차수내고정적개량수술기술. 방법 2006년1월지2009년12월공수치8례고골간골절강판내고정실효환자,남7례,녀1례；평균년령위41.1세(19 ～61세).7례환자강판단렬,1례환자강판미단단라정발출,골절균미획유합.수차수술지강판실효접수본차수술시간평균위12.4개월(4～30개월).수술보취:①X선궤투시하경피폐합취출소유라정,류치강판；②동측혹대측가골취골,차보취가유령일조수술인원여보취①동시진행；③치입수내정；④절개골절단,취출강판,학인대위량호,청리반흔조직병식골；⑤수내정원단쇄정.5례환자채용순행수내정고정,2례채용역행수내정고정,1례채용고골근단수내정고정. 결과 8례환자균순리완성경환수내정고정수술,수술시간평균위2.6 h(2.0～3.5 h),술중실혈량평균위1100 mL(600 ～ 1500 mL).술후1년수방8례환자골절균획유합,유합시간평균위5.5개월(4～8개월),무감염등기타병발증발생. 결론 본문소개소적개량수술기술가감소고골간골절불유합반강판내고정실효후행재차수내고정적수술실혈량,기기술난점위경피폐합취정급경화수강적재통.
Objective To report a modified surgical technique of intramedullary nailing to treat failed plating for femoral shaft fractures.Methods From January 2006 to December 2009,we treated 8 patients with non-union of femoral shaft fracture after plating failure.They were 7 men and one woman,with an average age of 41.1 years (from 19 to 61 years).Plate breaking occurred in 7 patients and screw pull-out in one.The average interval between the primary surgery and the salvage surgery after non-union was 12.4 months (from 4 to 30 months).The surgical procedures were:1.percutaneous screw removal under X-ray with the plat retained; 2.ipsilateral or contralateral harvest of the iliac graft,which was done simultaneously as step 1 by another team; 3.implantation of intramedullary nails; 4.opening the fracture site,removing the plate,confirming alignment,cleaning the scar tissue and grafting; 5.distal locking of intramedullary nails.Anterograde nails were used in 5 cases,retrograde ones in 2 and the femoral proximal nail in one.Results The secondary surgery was successfully completed in all cases to change the intramedullary nailing.The average surgery time was 2.6 hours (from 2.0 to 3.5 hours),and the average surgical blood loss was 1100 mL (from 600 to 1500 mL).The one-year follow-up showed fracture union in all the 8 cases after an average time of 5.5 months (from 4 to 8 months),with no infection or other complications.Conclusions This modified surgical technique of intramedullary nailing can significantly reduce blood loss during the revision surgery for the non-union of femoral shaft fracture after plating failure.The percutaneous screw removal and the recanalization of hardened marrow cavity may be 2 technical difficulties.
