CAJ | 학술논문

背景:对于股骨干粉碎性骨折、非峡部骨折、骨缺损等髓内钉固定后骨不连患者,更换髓内钉治疗的临床疗效并不理想.目的:对18例应用附加侧板联合植骨治疗的股骨干骨折髓内钉固定后非感染性骨不连患者进行回顾性分析,观察附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效.方法:选择2001年4月至2011年6月在武警江苏省总队医院住院的股骨干骨折髓内钉固定后非感染性骨不连患者18例.所有患者均保留原髓内钉,附加6-11孔动力加压钢板或锁定加压钢板,远、近端各拧入2-4枚普通或锁定、单或双皮质螺钉,同期行自体髂骨植骨术.随访观察患者骨折愈合情况.根据Tohner-Wrnch 标准评定附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连的临床疗效.结果与结论:所有病例均获得随访,随访时间6-21个月,平均16个月.X 射线片结果显示治疗后患者骨性愈合率为100%;其中13例患者于治疗后6-9个月达到骨性愈合,另5例患者于治疗后10-11个月达到骨性愈合.Tohner-Wrnch 标准评定结果显示附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连的优良率为100%.且植入物无腐蚀、断裂等情况,无植入物宿主反应.可见保留原髓内钉、附加侧板联合植骨治疗股骨干骨折髓内钉固定后非感染性骨不连临床疗效满意,是一种比较理想的治疗方法.
배경:대우고골간분쇄성골절、비협부골절、골결손등수내정고정후골불련환자,경환수내정치료적림상료효병불이상.목적:대18례응용부가측판연합식골치료적고골간골절수내정고정후비감염성골불련환자진행회고성분석,관찰부가측판연합식골치료고골간골절수내정고정후비감염성골불련적료효.방법:선택2001년4월지2011년6월재무경강소성총대의원주원적고골간골절수내정고정후비감염성골불련환자18례.소유환자균보류원수내정,부가6-11공동력가압강판혹쇄정가압강판,원、근단각녕입2-4매보통혹쇄정、단혹쌍피질라정,동기행자체가골식골술.수방관찰환자골절유합정황.근거Tohner-Wrnch 표준평정부가측판연합식골치료고골간골절수내정고정후비감염성골불련적림상료효.결과여결론:소유병례균획득수방,수방시간6-21개월,평균16개월.X 사선편결과현시치료후환자골성유합솔위100%;기중13례환자우치료후6-9개월체도골성유합,령5례환자우치료후10-11개월체도골성유합.Tohner-Wrnch 표준평정결과현시부가측판연합식골치료고골간골절수내정고정후비감염성골불련적우량솔위100%.차식입물무부식、단렬등정황,무식입물숙주반응.가견보류원수내정、부가측판연합식골치료고골간골절수내정고정후비감염성골불련림상료효만의,시일충비교이상적치료방법.
BACKGROUND: For the patients with nonunions of femoral shaft comminuted fractures, non-isthmus and bone defects after treated with intramedul ary nail fixation, the clinical efficacy of replacing the intramedul ary nail is not satisfactory. OBJECTIVE: To observe the therapeutic effect of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedul ary nail fixation through a retrospective analysis of 18 cases. METHOIDS: Al the 18 cases with aseptic nonunions of femoral shaft fractures after intramedul ary nail fixation were selected from Jiangsu Provincial Corps Hospital of the Chinese People’s Armed Police Force from April 2001 to June 2011. Al patients retained the original intramedul ary nail, augmentation plating of 6 to 11 holes dynamic compression plate or locking compression plate, wrenching 2 to 4 screws (locking or common, single or double cortex) in the proximal or distal end. Al cases undertook the autogenoas iliac crest bone grafting at the same time. The fol ow-up results were used to observe the fracture healing of the patients. The clinical effect of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedul ary nail fixation was evaluated according to the Tohner-Wrnch standard. RESULTS AND CONCLUSION: Al cases were fol owed-up for 6-21 months, average in 16 months. X-ray film showed that the bone healing rate was 100%; among the cases, 13 cases achieved osseous union within 6-9 months, while the other five patients achieved osseous union within 10-11 months. Tohner-Wrnch standard assessment results showed the bone healing rate of augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedul ary nail fixation was 100%, no corrosion, breakage or hosting reaction of implant was found in al patients. Retaining the original intramedul ary nail and augmentation plating with bone grafting for aseptic nonunions of femoral shaft fractures after intramedul ary nail fixation has a satisfied clinical efficacy, it is an ideal treatment method.