附加钢板治疗髓内钉固定后股骨肥大性骨不连

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1、附加钢板治疗髓内钉固定后股骨肥大性骨不连张建政刘智孙天胜李京生任继鑫刘树清胥少汀[摘要]目的探讨附加钢板治疗髓内钉固定后股骨肥大性骨不连的安全性和有效性。方法1998年4月～2008年6月，应用附加钢板治疗9例髓内钉固定后股骨肥大性骨不连，1例为股骨上1/3，5例为股骨中1/3，3例为股骨下1/3。采用4～6孔钛合金限制接触性窄动力接骨板，4～6枚皮质骨螺钉固定。6例骨不连间隙大于5mm，4例采用单纯髂骨植骨，2例固骼生和髂骨混合植骨。3例小于5mm，1例植入固骼生，2例将修整的骨痂重新植入。术后保护性负重

2、防止主钉断裂失效，逐渐恢复术前活动水平，术后1、3、6、12个月临床与影像学随诊。结果6例取髂骨植骨和附加钢板固定手术时间共60～120min，出血量100～300ml。3例单纯附加钢板手术时间40～100min，出血量60～100ml。供骨区疼痛4例，3例1月内缓解，1例3月后缓解，无感染、钢板螺钉松动、断裂等。平均愈合时间8个月，5例术后6～11个月取出髓内钉和钢板。结论附加钢板有效改善局部旋转不稳定，是治疗髓内钉固定后股骨肥大性骨不连的有效方法之一。【关键词】股骨骨折；髓内钉；固定；骨不连；附加钢板A

3、ugmentativePlateFixationtoTreatFemoralHypertrophicNonunionsSubsequenttoIntramedullaryNailingZHANGJian-zheng,LlUZhi,SUNTian-sheng,etat.DepartmentofOrthopaedics,GeneralHospitalofBeijingMilitaryCommand,Beijing100700,China[Abstract]ObjectiveToinvestigatetheeff

4、ectofaugmentativeplatefixationtoincreasestabilityintreatmentoffemoralshaftnonunionssubsequenttointramedullaryfixation.MethodsNinefemoralnonunionsafterintramedullarynailinternalfixationweretreatedwithaugmentativeplateinternalfixationfromApril1998toJane2008,

5、whichweremanagedwithalockednailinternalfixation.Allfemoralnonunionswerecausedbyinsecurefixationoftheintramedullarynailing,inwhicharotationalinstabilityofthefracturesitewasverifiedinallcasesduringoperation.Leavingtheintramedullarynailinsitu,anaugmentativepl

6、atefixationwasappliedtothefracturesitetocountertherotationalinstability.Ageneralplatewithatleasttwoscrewsreachingtheoppositecorticalboneaboveandbelowthefracturewasfixatedtothelateralsideoftheboneshaft.Inallpatients,therewasvisiblemotionatthefracturesite，ho

7、wever,themotiondisappearedafterplateaugmentation.ResultsAllpatientsachievedradiologicalsolidunionatanaverageof8months(range,6to11months).Theirhardwarewasremovedin6to11monthsafteroperationinfivecases.Noinfection,hardwarelooseningorbreakingwasfound.Conclusio

8、nsTheaugmentativeplatefixationcanbeappliedatthefracturesitetopreventtherotationalinstability.Thetechniqueissimpleanddoesnotrequireanyspecialinstrument,whichfacilitatesanearlyweightbearingandgivesaquickrecover