• 武警江蘇省總隊(duì)醫(yī)院骨科（江蘇揚(yáng)州，225003）;

目的比較更換髓內(nèi)釘和保留髓內(nèi)釘、附加側(cè)板治療股骨干骨折髓內(nèi)釘固定術(shù)后非感染性骨不連的療效。 方法回顧性分析2001年6月－2011年6月收治的股骨干骨折髓內(nèi)釘固定術(shù)后非感染性骨不連患者28例，采用更換髓內(nèi)釘治療11例（A組），采用擴(kuò)髓保留髓內(nèi)釘、附加側(cè)板治療17例（B組）。兩組性別、年齡、吸煙與否、骨折部位、國(guó)際內(nèi)固定協(xié)會(huì)（AO/ASIF）分型、損傷類型、合并傷、骨不連類型、骨不連時(shí)間等一般資料比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。術(shù)后定期隨訪行臨床檢查及攝X線片，觀察膝關(guān)節(jié)活動(dòng)和骨痂生長(zhǎng)情況；根據(jù)Tohner-Wrnch標(biāo)準(zhǔn)評(píng)定臨床療效。 結(jié)果A組手術(shù)時(shí)間、術(shù)中出血量、術(shù)中輸懸浮紅細(xì)胞量均顯著多于B組（P  lt; 0.05），兩組術(shù)后引流量、住院時(shí)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。兩組切口均Ⅰ期愈合，無(wú)血管、神經(jīng)損傷發(fā)生。兩組患者均獲隨訪，隨訪時(shí)間12～36個(gè)月，平均18.6個(gè)月。兩組患者均獲骨性愈合，其中B組臨床骨愈合時(shí)間和影像學(xué)骨愈合時(shí)間均優(yōu)于A組（P  lt; 0.05）。隨訪期間兩組均無(wú)內(nèi)固定物松動(dòng)、斷裂，骨折復(fù)位丟失，成角或旋轉(zhuǎn)畸形愈合等并發(fā)癥發(fā)生。末次隨訪時(shí)，根據(jù)Tohner-Wrnch標(biāo)準(zhǔn)評(píng)定療效：A組獲優(yōu)6例，良3例，差2例，優(yōu)良率81.8%；B組獲優(yōu)12例，良5例，優(yōu)良率100%；兩組比較差異有統(tǒng)計(jì)學(xué)意義（Z=—2.623，P=0.021）。 結(jié)論與更換髓內(nèi)釘相比，應(yīng)用保留原髓內(nèi)釘、附加側(cè)板治療股骨干骨折髓內(nèi)釘固定術(shù)后非感染性骨不連，其操作相對(duì)簡(jiǎn)便、手術(shù)時(shí)間短、術(shù)中出血少、創(chuàng)傷輕，臨床療效滿意，是一種較理想的治療方法。

引用本文： 茹江英,倉(cāng)海濱,胡傳亮,胡玉華. 兩種方法治療股骨干骨折髓內(nèi)釘固定后非感染性骨不連的療效比較. 中國(guó)修復(fù)重建外科雜志, 2013, 27(1): 25-29. doi: 復(fù)制

1. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma, 2002, 16(6): 394-402.
2. Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
3. Ueng SW, Chao EK, Lee SS, et al. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma, 1997, 43(4): 640-644.
4. Johanson NA, Liang MH, Daltroy L, et al. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg (Am), 2004, 86-A(5): 902-909.
5. Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury, 2007, 38 Suppl 2: S19-22.
6. 趙剛, 張伯松, 孫林, 等. 帶鎖髓內(nèi)針治療股骨干骨折術(shù)后旋轉(zhuǎn)不穩(wěn)定所致不愈合的診斷和治療. 中華外科雜志, 2009, 47(16): 1232-1235.
7. Johner R, Raccaud O, Dournow J. Standard radiological study of the knee. Rev Med Suisse Romande, 1994, 114(4): 335-341.
8. 李寶文, 王東昕, 李學(xué)良, 等. 股骨干骨折術(shù)后不愈合25例臨床分析. 中國(guó)修復(fù)重建外科雜志, 2008, 22(6): 763-764.
9. Court-Brown CM, Keating JF, Christie J, et al. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg (Br), 1995, 77(3): 407-411.
10. Bhandari M, Schemitsch EH. Bone formation following intramedullary femoral reaming is decreased by indomethacin and antibodies to insulin-like growth factors. J Orthop Trauma, 2002, 16(10): 717-722.
11. 劉振東. 擴(kuò)髓換釘治療股骨干無(wú)菌性骨不連. 中華創(chuàng)傷骨科雜志, 2005, 7(5): 470-472.
12. Banaszkiewicz PA, Sabboubeh A, McLeod I, et al. Femoral exchange nailing for aseptic nonunion: not the end to all problems. Injury, 2003, 34(5): 349-356.
13. Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
14. Park K, Kim K, Choi YS, et al. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop, 2011, 35(4): 581-585.
15. Nadkarni B, Srivastav S, Mittal V, et al. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma, 2008, 65(2): 482-486.
16. 張建政, 劉智, 孫天勝, 等. 附加鋼板治療髓內(nèi)釘固定后股骨萎縮性骨不連. 中華創(chuàng)傷雜志, 2011, 27(5): 451-455.
17. 劉智, 李連華, 孫天勝, 等. 附加鋼板與交鎖髓內(nèi)釘治療下肢長(zhǎng)骨干骨折后肥大性骨不連22例. 中華創(chuàng)傷雜志, 2011, 27(8): 702-704.
18. Lin CJ, Chiang CC, Wu PK, et al. Effectiveness of plate augmentation for femoral shaft nounion after nailing. J Chin Med Assoc, 2012, 75(8): 396-401.
19. Said GZ, Said HG, el-Sharkawi MM, et al. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop, 2011, 35(7): 1089-1092.
20. 張建政, 孫天勝, 劉智, 等. 更換髓內(nèi)釘與保留髓內(nèi)釘附加鋼板治療髓內(nèi)釘固定后股骨肥大性骨不連. 中華骨科雜志, 2011, 31(9): 949-954.
  1. 1. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma, 2002, 16(6): 394-402.
  2. 2. Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
  3. 3. Ueng SW, Chao EK, Lee SS, et al. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma, 1997, 43(4): 640-644.
  4. 4. Johanson NA, Liang MH, Daltroy L, et al. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg (Am), 2004, 86-A(5): 902-909.
  5. 5. Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury, 2007, 38 Suppl 2: S19-22.
  6. 6. 趙剛, 張伯松, 孫林, 等. 帶鎖髓內(nèi)針治療股骨干骨折術(shù)后旋轉(zhuǎn)不穩(wěn)定所致不愈合的診斷和治療. 中華外科雜志, 2009, 47(16): 1232-1235.
  7. 7. Johner R, Raccaud O, Dournow J. Standard radiological study of the knee. Rev Med Suisse Romande, 1994, 114(4): 335-341.
  8. 8. 李寶文, 王東昕, 李學(xué)良, 等. 股骨干骨折術(shù)后不愈合25例臨床分析. 中國(guó)修復(fù)重建外科雜志, 2008, 22(6): 763-764.
  9. 9. Court-Brown CM, Keating JF, Christie J, et al. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg (Br), 1995, 77(3): 407-411.
  10. 10. Bhandari M, Schemitsch EH. Bone formation following intramedullary femoral reaming is decreased by indomethacin and antibodies to insulin-like growth factors. J Orthop Trauma, 2002, 16(10): 717-722.
  11. 11. 劉振東. 擴(kuò)髓換釘治療股骨干無(wú)菌性骨不連. 中華創(chuàng)傷骨科雜志, 2005, 7(5): 470-472.
  12. 12. Banaszkiewicz PA, Sabboubeh A, McLeod I, et al. Femoral exchange nailing for aseptic nonunion: not the end to all problems. Injury, 2003, 34(5): 349-356.
  13. 13. Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
  14. 14. Park K, Kim K, Choi YS, et al. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop, 2011, 35(4): 581-585.
  15. 15. Nadkarni B, Srivastav S, Mittal V, et al. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma, 2008, 65(2): 482-486.
  16. 16. 張建政, 劉智, 孫天勝, 等. 附加鋼板治療髓內(nèi)釘固定后股骨萎縮性骨不連. 中華創(chuàng)傷雜志, 2011, 27(5): 451-455.
  17. 17. 劉智, 李連華, 孫天勝, 等. 附加鋼板與交鎖髓內(nèi)釘治療下肢長(zhǎng)骨干骨折后肥大性骨不連22例. 中華創(chuàng)傷雜志, 2011, 27(8): 702-704.
  18. 18. Lin CJ, Chiang CC, Wu PK, et al. Effectiveness of plate augmentation for femoral shaft nounion after nailing. J Chin Med Assoc, 2012, 75(8): 396-401.
  19. 19. Said GZ, Said HG, el-Sharkawi MM, et al. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop, 2011, 35(7): 1089-1092.
  20. 20. 張建政, 孫天勝, 劉智, 等. 更換髓內(nèi)釘與保留髓內(nèi)釘附加鋼板治療髓內(nèi)釘固定后股骨肥大性骨不連. 中華骨科雜志, 2011, 31(9): 949-954.