Birjandinejad Ali, Ebrahimzadeh Mohammad H, Ahmadzadeh-Chabock Hosein
Mashad Orthopedic Research Center, Mashad, Khorasan, Iran.
Orthopedics. 2009 Jun;32(6):409. doi: 10.3928/01477447-20090511-12.
Nonunion after intramedullary nailing of femoral and tibial fractures, although infrequent, remains a challenge for orthopedic surgeons. Augmentation plate fixation can be a reasonable choice in this situation. From 2003 to 2005, 38 patients (25 femoral nonunions and 13 tibial nonunions) were treated after intramedullary nailing with augmentation plate fixation, leaving the nail in situ, with or without autogenous cancellous bone graft. Patients were followed for at least 1 year postoperatively. All 25 femoral nonunions healed with solid union (100% union rate), but 2 of 13 tibial nonunions remained symptomatic and did not achieve union (84.6% union rate) at a mean 4.78 months postoperatively (range, 1-6 months). No serious complications were encountered at 1-year follow-up. We suggest augmentation plate fixation for femoral and tibial nonunion after intramedullary nailing.
股骨干和胫骨干骨折髓内钉固定术后骨不连虽不常见，但仍是骨科医生面临的挑战。在这种情况下，增加钢板固定可能是一个合理的选择。2003年至2005年，38例患者（25例股骨干骨不连和13例胫骨干骨不连）在髓内钉固定后采用增加钢板固定，髓内钉原位保留，同时或不联合自体松质骨移植。术后对患者进行至少1年的随访。所有25例股骨干骨不连均实现牢固愈合（愈合率100%），但13例胫骨干骨不连中有2例术后平均4.78个月（范围1 - 6个月）仍有症状且未实现愈合（愈合率84.6%）。1年随访时未出现严重并发症。我们建议对股骨干和胫骨干骨折髓内钉固定术后骨不连采用增加钢板固定。
