摘要
[目的]比较交锁髓内钉动力化治疗与非动力化治疗股骨干骨折非感染性延迟愈合的效果,以及动力化的方法和时机。[方法] 2010年2月～2017年9月,本科治疗50例股骨干骨折交锁髓内钉固定术后非感染性延迟愈合患者。其中,29例采用交锁髓内钉动力化治疗,21例非动力化治疗。动力化组中,19例于初次术后6个月内动力化(早期动力化),10例于6个月以上动力化(晚期动力化);13例动力化时仅去除静力锁钉,但仍保留动力锁定钉(部分动力化),16例去除全部锁定钉(完全动力化)。比较患者的骨愈合和肢体功能。[结果] 50例患者随访10～28个月,平均(16.35±2.13)个月。动力化组骨愈合时间明显早于非动力化组,差异有统计学意义[(8.68±1.97)个月vs (10.44±2.12)个月, P<0.05]。29例动力化治疗患者中,早期动力化愈合率为86.73%,显著高于晚期动力化的33.33%,二者间差异有统计学意义(P<0.05)。此外,部分动力化股骨干骨折愈合率为92.30%,而完全动力化为62.50%。二者差异有统计学意义(P<0.05)。[结论]对股骨干骨折锁定髓内钉术后非感染性延迟愈合,采用动力化治疗可加快骨折愈合,早期动力化优于晚期动力化,部分动力化优于完全动力化。
[Objective] To compared the clinical outcomes of dynamization versus non-dynamization treatment for non-infectious delayed union of femoral shaft fractures after interlocking intramedullary nailing, and explore method and timings of the dynamization. [Methods] A retrospective study was conducted on 50 patients who were treated in our department from February 2010 to July 2017 including 29 patients treated with dynamization and 21 patients received non-dynamization technique for non-infectious delayed union of femoral shaft fracture after interlocking intramedullary nailing. Of the 29 patients who received dynamization treatment, 19 patients underwent dynamization within 6 months （the early dynamization） and 10 patients had the nail dynamized more than 6 months （the late dynamization） after primary nailing in term of timing, while 13 patients had the static interlocking screw removed only with retention of the dynamic screw （the partial dynamization） and 16 patients had the distal interlocking screws removed totally （the complete dynamization） in term of method. The fracture healing and limb function were compared among the patients. [Results] The 50 patients were followed up for 10 to 28 months with an average of （16.35±2.13） months. The patients in the dynamization group got bony healing significantly earlier than those in the nondynamization [（8.68±1.97） months versus （10.44±2.12） months, P〈0.05]. Of the 29 patients in the dynamization group, the patients in the early dynamization subgroup had significantly higher bone-union rate than those in the late dynamization subgroup [86.73% versus 33.33%, P〈0.05] . On the other aspect, the patients in the partial dynamization subgroup got significantly higher bone-union rate than those in the complete dynamization subgroup [92.30% versus 62.50%, P〈0.05 ] . [Conclusion] For non-infectious delayed union of femoral shaft fractures after interlocking intramedullary nailing, dynamization of the nail does considerably accelerate bony union, the early dynamization is better than the late dynamization and the partial dynamization is superior to the complete dynamization.
作者
郑天雷
李岩
刘圣凯
张肖在
王陶然
袁志
ZHENG Tian-lei;LI Yan;LIU Sheng-kai;ZHANG Xiao-zai;WANG Tao-ran;YUAN Zhi(Department of Orthopedics,Xijing Hospital,Air Force Medical University,Xi＇an 710032,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第22期2017-2021,共5页
Orthopedic Journal of China
基金
国家自然科学基金面上项目(编号:81570801)
关键词
股骨干骨折
交锁髓内钉
延迟愈合
髓内钉动力化
femoral shaft fracture
interlocking intra-medullary nail
delayed union
dynamization
作者简介
郑天雷，硕士研究生，研究方向：四肢骨关节的创伤与修复，（电话）13309243697，（电子信箱）767223404@qq．com;通信作者：袁志，（电话）18629089666，（电子信箱）xjjilinyz@fmmn．edu．cn
