Brinker Mark R, O'Connor Daniel P
Fondren Orthopedic Group, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030-4509, USA.
J Bone Joint Surg Am. 2007 Jan;89(1):177-88. doi: 10.2106/JBJS.F.00742.
Exchange nailing is most appropriate for a nonunion without substantial bone loss. There is no clear consensus regarding the use of exchange nailing in the presence of active, purulent infection. The exchange nail should be at least 1 mm larger in diameter than the nail being removed, and it has been recommended that it be up to 4 mm larger when the nail being removed was greatly undersized. Canal reaming should progress until osseous tissue is observed in the reaming flutes. Exchange nailing is an excellent choice for aseptic nonunions of noncomminuted diaphyseal femoral fractures, with union rates reported to range from 72% to 100%. On the basis of the available literature, exchange nailing cannot be recommended for distal femoral nonunions at this time. Exchange nailing is an excellent choice for aseptic nonunions of noncomminuted diaphyseal tibial fractures, with union rates reported to range from 76% to 96%. On the basis of the available literature, exchange nailing is generally not indicated for humeral nonunions.
更换髓内钉最适合于无明显骨质丢失的骨不连。对于存在活动性化脓性感染时是否使用更换髓内钉，目前尚无明确共识。更换的髓内钉直径应比被取出的髓内钉至少大1毫米，有人建议当被取出的髓内钉尺寸明显过小时，更换的髓内钉直径应大4毫米。扩髓应持续进行，直到在扩髓槽中观察到骨质组织。更换髓内钉是治疗非粉碎性股骨干骨折无菌性骨不连的极佳选择，报道的愈合率在72%至100%之间。根据现有文献，目前不推荐对股骨远端骨不连使用更换髓内钉。更换髓内钉是治疗非粉碎性胫骨干骨折无菌性骨不连的极佳选择，报道的愈合率在76%至96%之间。根据现有文献，一般不建议对肱骨骨不连使用更换髓内钉。
