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股骨干骨折术后不愈合25例临床分析

【摘 要】 目的 总结股骨干骨折术后不愈合的原因及再手术方法。 方法 1999 年2 月－ 2007 年1 月，收治股骨干骨折术后不愈合患者25 例。男18 例，女7 例；年龄27 ～ 61 岁，平均42 岁。车祸伤14 例，坠落伤6 例，跌摔伤5 例。股骨干骨折部位：上段4 例，中段18 例，下段3 例。原固定方法：国产加压钢板内固定12 例，进口AO 加压钢板内固定4 例，髓内钉固定7 例，外固定架固定2 例。入院X 线片检查无连续骨痂，骨折线明显。骨折至本次手术时间8 ～ 16 个月。术中采用AO 股骨交锁髓内钉固定16 例，AO 加压钢板内固定7 例，AO 单管单臂架外固定2 例。 结果 患者术后切口均Ⅰ期愈合。25 例均获随访6 ～ 14 个月，平均9.4 个月。骨折愈合时间为4 ～ 12 个月，平均7.2 个月。根据Tohner-Wrnch 标准证定临床疗效；优14 例，良9 例，差2 例，优良率92%。 结论 采用恰当内固定方式、术中操作仔细、术后进行正确功能锻炼是治疗股骨干骨折术后不愈合的关键。

Reamed versus Nonreamed Intramedullary Nailing for Femoral Fractures: A Systematic Review

Objective　To evaluate the effectiveness of reamed versus nonreamed intramedullary nailing for femoral fractures. Methods　Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were identified from MEDLINE (1966-2004.5), EMBASE (1966-2004.5), Cochrane Library (Issue 2, 2004), Cochrane Musculoskeletal Injuries Group Database (2004.5), and CBM disc (1979-2004.5). We handsearched Chinese Journal of Orthopaedy (from establishment to May 2004) and Orthopaedic Journal of China (from establishment to May 2004) . RCTs and CCTs were included. Data were extracted by two reviewers with designed extraction form. RevMan 4.2.3 software was used for data analysis. Results　Five RCTs and two CCTs were included. The combined results of meta-analysis showed that reamed intramedullary nailing for femoral fractures can reduce the rate of nonunion (RR=0.38, 95%CI 0.17 to 0.83, P=0.01) and the rate of implant failure (RR=0.42, 95%CI 0.20 to 0.89, P=0.02). Conclusions　Compared with nonreamed intramedullary nailing for femoral fractures, reamed intramedullary nailing can reduce the rates of nonunion and implant failure. However, the relation between reaming or pulmonary complications, the time of union, infection, malunion, operative time, and blood loss needs further study.

交锁髓内钉治疗股骨干骨折

目的 总结交锁髓内钉治疗股骨干骨折的临床经验。方法 2000年6月~2004年6月，收治股骨干骨折35例，男21例，女14例；年龄16～69岁，平均31.5岁。其中车祸伤19例，摔伤6例，工地外伤3例，坠落伤7例。开放性骨折13例，Anderson分型Ⅰ型8例，Ⅱ型5例；闭合性骨折22例。新鲜骨折于伤后4 h~5 d、陈旧性骨折于伤后25~56 d入院。35例均采用交锁髓内钉治疗。结果 35例获随访6~49个月。术后达骨性愈合25例(71.4%)，平均愈合时间5.4个月，12~16个月取出内固定；4~8个月临床愈合9例(25.7%)；5个月骨折延迟愈合1例，经取出上端横行锁钉，改为动力型髓内钉固定4个月后骨性愈合。随访期内无感染，髓内钉无折弯和折断，无畸形愈合；锁钉折断与退出各1例。35例功能锻炼后，髋、膝关节功能均基本恢复正常。结论 交锁髓内钉能防止肢体短缩和旋转，骨折固定牢靠，愈合率高，是治疗股骨干骨折的首选内固定方法。

ELECTROMAGNETIC NAVIGATION INTERLOCKING INTRAMEDULLARY NAIL TECHNOLOGY FOR TREATMENT OF FEMORAL SHAFT FRACTURES

Objective To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Methods Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as typeⅡ, 22 cases as typeⅢ, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. Results The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and good rate of 98%. Conclusion Electromagnetic navigation system is safe and reliable, with the advantages of high positioning accuracy, short operation time, and no radiation, the clinical application of the system for distal locking nail operation can obtain excellent short-term effectiveness.

Effects of Rehabilitation Education and Training Interventions on Perioperative Patients with Femoral Shaft Fractures

【摘要】　目的　探讨康复宣教与训练等干预手段对股骨干骨折患者围手术期的影响。　方法　2010年6月－2011年3月收治股骨干骨折患者90例，其中男48例，女42例；年龄17~58岁，平均38岁。开放性骨折28例，闭合性骨折62例。股骨骨折部位:上1/3骨折33例，中1/3骨折35例，下1/3骨折20例，多段骨折2例。横形骨折20例，斜形骨折30例，粉碎性骨折40例。将90例患者随机分为康复组（46例）和对照组（44例）。对照组采用骨科术前常规处理，康复组采用骨科术前常规处理加康复宣教与训练。　结果　康复组住院时间为（5.35±1.27） d，对照组为（7.67±1.85） d，两组比较差异有统计学意义（Plt;0.05）。 康复组治疗后发生并发症7例，对照组16例，康复组并发症发生率（15.2%）明显低于对照组（36.4%），差异有统计学意义（Plt;0.05）。治疗后5 d，康复组疗效获优35例，良6例，可3例，差2例，优良率89.1%；对照组获优25例，良5例，可12例，差2例，优良率68.2%；两组疗效比较差异有统计学意义（Plt;0.05）。　结论　康复宣教与训练能预防与改善股骨干骨折围手术期卧床引起的并发症，减轻患者腿部疼痛及肿胀，缩短围手术期时间，使患者能尽早手术，加快住院床位周转，提高患者生活质量。【Abstract】　Objective　To explore the effects of rehabilitation education and training interventions on perioperative patients with femoral shaft fractures.　Methods　A total of 90 patients with femoral shaft fractures were selected from June 2010 to March 2011, including 48 males and 42 females aged from 17 to 58 years (mean 38 years). In these 90 patients, open fracture was in 28 and closed fracture was in 62. Fracture site: upper 1/3 fracture was in 33, middle 1/3 fracture was in 35, lower 1/3 fracture was in 20 and multiple fractures was in 2. There were transverse fractures in 20 patients, oblique fractures in 30 patients and comminuted fractures in 40 patients. All of the patients were randomly divided into experimental group (46 patients) and control group (44 patients). The patients in the control group underwent the routine treatment before the orthopedic surgery; besides the routine treatment, the patients in the experimental group were given the rehabilitation education and training before the orthopedic surgery.　Results　The hospital duration in the rehabilitation group was (5.35±1.27) days while in the control group was (7.67±1.85) days, the difference was statistically significant (Plt;0.05). There were 7 cases who had complications in rehabilitation group compared with 16 patients in the control group; the incidence of the complications in the rehabilitation group (15.2%) was significantly lower than that in the control group (36.4%) (Plt;0.05). After the treatment for 5 days, the therapeutic effect in rehabilitation group were excellent in 35 cases, good in 6 cases, middle in 3 cases and poor in 2 cases (with the good rate of 89.1%); while in the control group were excellent in 25 cases, good in 5 cases, middle in 12 cases and poor in 2 cases (with the good rate of 68.2%); the difference was significant between the two groups (Plt;0.05).　Conclusion　Rehabilitation education and training could prevent the perioperative complications in patients with femoral shaft fracture, decrease the pain and edema, speed up the turnover of hospital beds, and improve the patients’ quality of life.

股内收肌群痉挛致老年严重骨质疏松患者股骨干再骨折一例

DEVELOPMENT AND CLINICAL APPLICATION OF AN INTRAMEDULLARY CONTROLLED DYNAMIC NAI LING

Objective To describe the design and application of a new intramedullary controlled dynamic nailing(ICDN).〓〖WTHZ〗Methods The new ICDN was made of a stainlesssteel alloy, consists of a nail shaft, innerrod, tensile screw, end cape and two interlocked screws. From December 2005 toFebruary 2007, 48 cases of femoral shaft fractures were treated with ICDN. There were 16 females and 32 males with a mean age of 36.6 years (range, 16-48years). Injury was caused by traffic accident in 26 cases, falling from a height in14, sportsrelated in 7 and crush injury in 1 case. According to Winquist classification, Thirtyseven cases were classified as typeⅠ(13 cases of typeⅠ-1,23 cases of Ⅰ-2 and 1 case of Ⅰ-3), eleven as type Ⅱ fracture ( 2 cases oftype Ⅱ-1, 8 cases of Ⅱ-2 and 1 case of Ⅱ-3). The time from injury to admission was an hour to a week. Emergency operation was performed in 19 cases and the other 29 patients were given operation within 3 days. Results All cases were followed up for an average of 5 months (3-12 months). Among them, the average healing period was 21 weeks (826 weeks) and no nonunion, delayed union and breakage of nailings occurred. The complications included 2 infections, 5 pains, and 4 deformities. Based on Johner and Ｗrubs standard, the results were excellent in 39 cases, good in 7 cases and fair in 2 cases, The excellent and good rate was 95.8%. Conclusions ICDN has excellent biomechanical characteristics which can provide a flexible fixation in treating femoral shaft fractures. The operation is simple and is one of the good techniquesin treating femoral shaft fractures.

股骨干骨折伴大腿中段Morel-Lavallée损伤一例

APPLICATION OF AUTO-CONTROL MICRO-MOTION INTRAMEDULLARY LOCKING NAIL IN THE TREATMENTOF FEMORAL SHAFT FRACTURES

【Abstract】 Objective The auto-control micro-motion intramedullary locking nail (AMLN) is designed, to reducethe incidence of delayed union and non-union of femoral shaft fractures fixed by interlocking intramedullary nails, and toobserve the cl inical effect of self-design AMLN in the treatment of femoral shaft fractures. Methods The distal and promixalnails were connected by the micro-motion locking structure, which could cause 1.0-1.5 mm axial micro-motion between fracture gaps. It could produce physical stimulus and conduction between fracture gaps in the course of fracture union. From December 2003 to May 2006, 32 cases of femoral shaft fractures were treated with AMLN, including 21 males and 11 females with the average age of 31.2 years (ranging from 20 years to 43 years). The trauma resulted from fall wounds in 3 cases, crash injuries in 1 case and car accidents in 28 cases. Twenty-nine cases were fresh fractures in different parts of the femoral shaft with transverse, obl ique, spiral and comminuted fractures of type I, II, III and IV. Three cases were old non-union fractures. The fresh fractures were treated by closed AMLN fixation, while the old fractures were treated by open AMLN nails after routine implantation of self bone. Results All the 32 cases were followed up for the average time of 11.5 months (rangeing from 8 months to 22 months). The X-ray films showed the fractures were healed 4.0 to 7.5 months after the operation, with the mean time of 5.1 months, and no break of the nail happened. One nail mildly bent in the comminuted fracture, and 2 patients felt sl ightly unwell at the needl ing point. According to the Klemm criterion for function, 26 cases were excellent, 5 good, 1 fair, and the choiceness rate was 96.88%. Conclusion With a suitable design, AMLN is easy to perform and helpful to quicken fracture union, and it is effective to treat femoral shaft fractures.

克氏针提拉复位髓内钉固定治疗粉碎性股骨干骨折

目的 总结克氏针提拉闭合复位、交锁髓内钉内固定治疗粉碎性股骨干骨折的临床疗效。 方法 2008 年4 月－ 2010 年3 月，采用克氏针提拉闭合复位、交锁髓内钉内固定治疗新鲜粉碎性股骨干中段骨折23 例。其中男19 例，女4 例；年龄27 ～ 55 岁，平均35 岁。致伤原因：交通事故伤18 例，重物砸伤5 例。左侧10 例，右侧13 例。骨折按Winquist-Hansen 分级：Ⅰ级11 例，Ⅱ级6 例，Ⅲ级3 例，Ⅳ级3 例。受伤至手术时间2 ～ 5 d。 结果 手术时间40 ～ 90 min，平均55 min；术中出血量100 ～ 500 mL，平均310 mL。术后切口均Ⅰ期愈合。23 例均获随访，随访时间13 ～ 30 个月，平均16 个月。X 线片示22 例骨折愈合良好，愈合时间8 ～ 17 个月，平均13 个月；1 例Ⅳ级骨折患者因活动过多，骨折愈合迟缓，经予以制动4 个月后愈合。无深静脉血栓形成、断钉、感染等并发症发生。末次随访时按刘兴炎等股骨干骨折疗效评定标准，获优22 例，良1 例，优良率达100%。 结论 克氏针提拉闭合复位交锁髓内钉内固定治疗粉碎性股骨干骨折，手术方法简便、并发症少、骨折愈合率高。