| 两种内固定方式治疗交锁髓内钉固定后股骨骨不连的比较研究 |
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投稿时间：2024-12-07
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| 作者 | Author | 单位 | Address | E-Mail |
| 侯吴仁 |
HOU Wu-ren |
临海市第二人民医院骨科, 浙江 临海 317016 |
Department of Orthopaedics, the Second People's Hospital of Linhai City, Linhai 317016, Zhejiang, China |
1985034921@qq.com |
| 徐安鹏 |
XU An-peng |
临海市第二人民医院骨科, 浙江 临海 317016 |
Department of Orthopaedics, the Second People's Hospital of Linhai City, Linhai 317016, Zhejiang, China |
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| 徐敏鸥 |
XU Min-ou |
临海市第二人民医院骨科, 浙江 临海 317016 |
Department of Orthopaedics, the Second People's Hospital of Linhai City, Linhai 317016, Zhejiang, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第4期，第378-383页 |
| DOI：10.12200/j.issn.1003-0034.20240657 |
| 基金项目: |
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中文摘要:
目的: 比较分析动力化固定和附加钢板固定联合植骨术治疗交锁髓内钉静力型固定后股骨骨不连的疗效。
方法: 回顾性分析2008年1月至2022年12月采用髓内钉动力化固定和附加钢板固定联合植骨术(保留髓内钉)治疗128例交锁髓内钉静力型固定后股骨骨不连患者,男104例,女24例;年龄19~59(32.70±9.21)岁。根据治疗方法不同分为动力化组和钢板组。动力化组67例,男54例,女13例;年龄19~58(32.68±9.33)岁;行切开复位、顺行交锁髓内钉固定术,术后10~28个月行动力化固定。钢板组61例,男50例,女11例;年龄20~59(32.84±9.07)岁;行切开复位、顺行交锁髓内钉固定术,术后10~30个月行钢板加强固定术。对两组患者切口长度、手术时间、术中失血量、住院时间、骨折愈合情况及并发症等进行比较。
结果: 所有患者获1年以上随访,动力化组随访时间(26.12±11.82)个月,钢板组为(26.57±12.48)个月,差异无统计学意义(P>0.05)。动力化组手术切口长度(2.73±1.21) cm、手术时间(22.73±3.20) min及术中失血量(19.06±6.22) ml,均小于钢板组(22.53±2.24) cm、(126.40±13.91) min和(237.36±81.56) ml,差异有统计学意义(P<0.05)。钢板组所有患者骨折顺利愈合,愈合时间4~7(6.16±0.99)个月。动力化组共42例骨折愈合,愈合时间4~8(6.26±1.23)个月。两组骨折愈合率的差异有统计学意义(P<0.05),而愈合时间差异无统计学意义(P>0.05)。钢板组治疗费用为(17 700.18±4 846.27)元,动力化组为(334.24±18.16)元,两组治疗费用的差异有统计学意义(P<0.05)。
结论: 动力化固定和附加钢板固定联合植骨术均是治疗交锁髓内钉静力型固定后股骨增生型骨不连的有效方法,但动力化固定具有操作简便、创伤小、节省医疗费用等优点,优于附加钢板固定联合植骨术。然而,动力化固定不适用于股骨萎缩型骨不连的治疗。 |
| 【关键词】股骨骨折 骨不连 内固定 交锁髓内钉 动力化 |
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| A comparative study of two internal fixation techniques for femoral nonunion after intramedullary nails |
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ABSTRACT
Objective To compare the effectiveness of dynamic fixation and plate augmentation combined with bone grafting for femoral nonunion after interlocking intramedullary nails.
Methods Between January 2008 and December 2022,a total of 128 patients who developed femoral nonunion following static fixation with interlocking intramedullary nailing were retrospectively analyzed. All patients underwent either dynamic intramedullary nail fixation or plate fixation with bone grafting while retaining the original intramedullary nail. There were 104 males and 24 females;the age ranged from 19 to 59 years old with an average of (32.70±9.21) years old. Patients were categorized into dynamization group and plate group based on the distinct treatment modalities. There were 67 patients in the dynamization group,comprising 54 males and 13 females. The age range was from 19 to 58 years old,with a mean age of (32.68±9.33) years old. All patients underwent open reduction and anterograde interlocking intramedullary nail fixation. Dynamic fixation was implemented between 10 and 28 months postoperatively.The plate group comprised 61 patients,of whom 50 were male and 11 were female. The age distribution ranged from 20 to 59 years old,with a mean age of (32.84 ±9.07) years old. All patients underwent open reduction and anterograde interlocking intramedullary nailing. Plate reinforcement fixation was performed between 10 and 30 months postoperatively. The incision length,duration of surgery,intraoperative blood loss,hospitalization period,fracture healing status,and incidence of complications were compared between the two groups of patients.
Results All patients were followed up for a minimum duration of 1 year. The mean follow up period for the dynamization group was(26.12±11.82) months,compared to (26.57±12.48) months for the plate group. No statistically significant difference was observed between the two groups (P>0.05). The incision size (2.73±1.21) cm,operation time (22.73±3.20) min and blood loss (19.06±6.22) ml in the dynamization group were significantly less than those in the plate group (22.53±2.24) cm,(126.40±13.91) min and (237.36±81.56) ml,respectively (P<0.05). All nonunion in the plate group were successfully healed,and the healing time duration ranged from 4 to 7 months with an average of (6.16±0.99) months. In the dynamization group,a total of 42 patients achieved fracture healing,with a healing duration ranging from 4 to 8 months with an average of (6.26±1.23) months. There was significant difference in healing rate between 2 groups (P<0.05),but there was no significant difference in healing time between 2 groups (P>0.05). The average treatment cost was (17 700.18±4 846.27) yuan in the plate group and (334.24±18.16) yuan in the dynamization group,and there was significant difference in costs between 2 groups (P<0.05).
Conclusion Either dynamic fixation or plate augmentation combined with bone grafting is an effective method,but dynamic fixation is superior to plate augmentation combined with bone grafting for the treatment of femoral hyperplastic nonunion after interlocking intramedullary nails. Dynamic fixation offers several advantages,including simplified procedures,reduced trauma,and cost effectiveness in medical expenses,making it superior to additional plate fixation combined with bone grafting. However,dynamic fixation is not suitable for the treatment of femoral atrophic nonunion. |
| KEY WORDS Femoral fracture Nonunion Internal fixation Intramedullary nail Dynamization |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 侯吴仁,徐安鹏,徐敏鸥.两种内固定方式治疗交锁髓内钉固定后股骨骨不连的比较研究[J].中国骨伤,2025,38(4):378~383 |
| 英文格式: | HOU Wu-ren,XU An-peng,XU Min-ou.A comparative study of two internal fixation techniques for femoral nonunion after intramedullary nails[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(4):378~383 |
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