CAJ | 학술논문

目的：探讨股骨干骨折带锁髓内钉固定术后出现非感染性骨折不愈合及延迟愈合的原因，以及再次手术治疗的方法和疗效。方法回顾性分析我院2008年6月至2013年12月收治的股骨干骨折髓内钉固定术治疗的患者389例，其中骨折不愈合患者31例。分析造成骨折不愈合及延迟愈合的原因。治疗方法采用早期髓钉动力化的方法，如动力化后仍未愈合，采用骨折断端带蒂骨皮质剥离加自体骨植骨的方法，随访再次手术后的效果。结果股骨干中段1/3是股骨干骨折后经髓内钉固定治疗后骨折不愈合的易发部位。骨折不愈合的原因与原始治疗方法、骨折类型等密切相关。早期髓钉动力化可促进骨折愈合；单纯髓钉动力化后骨折仍难以愈合，行带蒂骨皮质剥离加自体骨植骨的方法可促进骨折愈合。结论股骨干骨折带锁髓内钉固定术后非感染性骨折不愈合的原因既有自身因素，又存在手术干预过程的力学、生物学因素，应根据其出现的原因及特点制定适当的治疗方案。
목적：탐토고골간골절대쇄수내정고정술후출현비감염성골절불유합급연지유합적원인，이급재차수술치료적방법화료효。방법회고성분석아원2008년6월지2013년12월수치적고골간골절수내정고정술치료적환자389례，기중골절불유합환자31례。분석조성골절불유합급연지유합적원인。치료방법채용조기수정동력화적방법，여동력화후잉미유합，채용골절단단대체골피질박리가자체골식골적방법，수방재차수술후적효과。결과고골간중단1/3시고골간골절후경수내정고정치료후골절불유합적역발부위。골절불유합적원인여원시치료방법、골절류형등밀절상관。조기수정동력화가촉진골절유합；단순수정동력화후골절잉난이유합，행대체골피질박리가자체골식골적방법가촉진골절유합。결론고골간골절대쇄수내정고정술후비감염성골절불유합적원인기유자신인소，우존재수술간예과정적역학、생물학인소，응근거기출현적원인급특점제정괄당적치료방안。
Objective To investigate the causes and treatment of femoral shaft fracture aseptic nonunion and delayed u-nion after interlocking intramedullary nailing. Methods In this study,389 cases from the orthopedic ward of our Hospital since July 2008 to December 2013 of femoral shaft fractures were treated with femoral nailing,31 patients with bone aseptic nonunion and delayed union after interlocking intramedullary nailing for femoral shaft fracture were treated. These patients were retrospectively analyzed. The early treatment methods was dynamization of intramedullary nail. If not yet healing,using pedicled bone cortex peel and autogenous iliac bone graft. The clinical outcomes of the secondary treatment were observed. Results The middle femoral 1/3 femoral shaft was the freQuently site of nonunion. The cause of nonunion was closely related with the o-riginal treatment,fracture type. Early dynamization of intramedullary nail could promote the healing of fracture;for dystrophic fracture nonunion,simple intramedullary nail force after fracture was difficult to heal,method of pedicled bone cortex stripping plus autologous iliac bone graft can promote fracture healing. Conclusion Many factors may contribute to fracture nonunion and delayed union after interlocking intramedullary nail fixation. Clinical outcomes of surgical treatment are good for nonunion and delayed union of femoral shaft fracture.