| 股骨近端骨折髓内钉术后感染性骨不连的手术治疗 |
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投稿时间：2018-03-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 翟利锋 |
ZHAI Li-feng |
浙江省立同德医院, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 马苟平 |
MA Gou-ping |
浙江省立同德医院, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 沈立锋 |
SHEN Li-feng |
浙江省立同德医院, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 郭峭峰 |
GUO Qiao-feng |
浙江省立同德医院, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 张春 |
ZHANG Chun |
浙江省立同德医院, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
2644817118@qq.com |
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| 期刊信息：《中国骨伤》2018年，第31卷，第5期，第413-419页 |
| DOI：10.3969/j.issn.1003-0034.2018.05.004 |
| 基金项目: |
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中文摘要:
目的：探讨改良Ⅰ期手术治疗股骨近端骨折髓内钉术后感染性骨不连的方法和疗效。
方法：2010年6月至2015年6月采用改良Ⅰ期清创修复的手术方法治疗股骨近端骨折髓内钉术后感染性骨不连患者10例，其中男9例，女1例；年龄35~77岁。单纯股骨转子间骨折3例，股骨转子间合并股骨近端骨折2例，股骨转子下骨折5例。在彻底清创的基础上以股骨近端LISS钢板重新固定骨折端，用吻合血管游离腓骨移植加混有抗生素人工骨的自体松质骨植骨修复大段骨缺损，术后及早开始不负重关节功能锻炼。
结果：所有患者获得随访，时间9~30个月。10例患者骨折均顺利愈合，随访期间无内固定断裂失效及感染复发病例，完全负重时间12~28周。末次随访采用Sanders创伤后髋关节评分标准评估术后髋关节功能：优7例，良2例，差1例。
结论：改良Ⅰ期分次清创游离腓骨移植加载抗生素人工骨混合自体骨植骨LISS钢板固定的方法治疗股骨近端骨折髓内钉术后感染性骨不连，骨折愈合率高，髋关节功能恢复满意。在彻底清创的基础上综合运用控制感染与改善骨折愈合条件的各项措施是手术取得成功的关键。 |
| 【关键词】股骨 髋骨折 骨折固定术,髓内 感染 骨折,不愈合 骨移植 |
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| Modified one-stage revision procedure for treating proximal femoral infected nonunion after intramedullary nail fixation |
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ABSTRACT
Objective: To explore the methods and results of modified one-stage revision procedure for treating proximal femoral infected nonunion after intramedullary nail fixation.
Methods: From June 2010 to June 2015, 10 patients of proximal femoral infected nonunion after intramedullary nail fixation were treated with modified one-stage revision procedure, including 9 males and 1 female, ranging in age from 35 to 77 years old. There were 3 cases of intertrochanteric fractures, 2 cases of intertrochanteric fractures accompanied with proximal femoral fractures and 5 cases of subtrochaneric fracures. The fractures ware fixed by LISS plate after radically debridement. The bone defects were repaired by free vascularized fibular graft and autogenous cancellous bone graft mixed artificial bone containing antibiotics. Postoperatively, ambulation without weight bearing was encouraged as early as possible.
Results: Ten patients were followed up from 9 to 30 months and all nonunions healed smoothly without wound infection recurrence or internal fixation failure at the final follow-up. The time for full weight bearing was from 12 to 28 weeks. The hip joint function was evaluated by Sanders Traumatic Hip Rating Scale, the result was excellent in 7 cases, good in 2, and fair in 1 at the final follow-up.
Conclusion: Modified one-stage revision procedure is an effective treatment with a good functional result for proximal femoral infected nonunion after intramedullary nail fixation. On the basis of radical debridement, the combination of infection control and bone healing therapeutic techniques is key for success. |
| KEY WORDS Femur Hip fractures Fracture fixation,intramedullary Infection Fractures,ununited Bone transplantation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 翟利锋,马苟平,沈立锋,郭峭峰,张春.股骨近端骨折髓内钉术后感染性骨不连的手术治疗[J].中国骨伤,2018,31(5):413~419 |
| 英文格式: | ZHAI Li-feng,MA Gou-ping,SHEN Li-feng,GUO Qiao-feng,ZHANG Chun.Modified one-stage revision procedure for treating proximal femoral infected nonunion after intramedullary nail fixation[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(5):413~419 |
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