Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2012 Aug;75(8):396-401. doi: 10.1016/j.jcma.2012.06.008. Epub 2012 Jul 24.
Treatment options for nonunion of the femoral shaft fracture after intramedullary nail fixation are controversial. The methods of exchanging an existing nail with a larger-sized nail, dynamization, removal of the nail followed by plating, and bone grafting have all been reported. From those options, exchange nailing seems to be the most popular choice. In our study, we used plate augmentation and bone grafting with retention of the nail. The purpose of our study was to evaluate the effectiveness of this method in treating femoral shaft nonunion after open reduction and internal fixation with intramedullary nail fixation.
Between January 2003 and December 2009, 22 patients who had nonunion after open reduction and internal fixation with intramedullary nail for femoral shaft fracture were included in our study. There were 13 men and nine women participants, with a mean age of 34.3 years (range, 17-77 years). The mean period of nonunion after surgery was 20.0 months (range, 7-63 months). The patients were classified into three groups, atrophic, oligotrophic, and hypertrophic. We retained the nail and performed plate augmentation for all patients, with simultaneous autologous bone grafting as indicated. We followed up on all patients with plain film examination, and to assess functional recovery status to determine osseous union condition.
All 22 of the patients achieved postoperative bony union uneventfully at a mean time of 22.1 weeks (range, 12-40 weeks). The mean operative time was 105 minutes (range, 60-150 minutes), and the mean blood loss was 340 ml (range, 150-700 ml). All of the patients could walk bearing full weight without pain within 3 months. There were no significant complications such as broken hardware, implant back-out, axial or rotational malalignment, or deep infections.
Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.
髓内钉固定治疗股骨干骨折不愈合的治疗方法存在争议。已报道的方法包括更换较大尺寸的钉、动力化、取出钉后行钢板固定、植骨等。其中，更换钉似乎是最受欢迎的选择。在我们的研究中，我们使用钢板增强和保留钉的植骨。我们研究的目的是评估这种方法治疗股骨干骨折切开复位内固定后不愈合的效果。
2003 年 1 月至 2009 年 12 月，我们对 22 例股骨干骨折切开复位内固定术后不愈合患者进行了研究。其中男性 13 例，女性 9 例，平均年龄 34.3 岁（17-77 岁）。术后不愈合时间平均为 20.0 个月（7-63 个月）。患者分为萎缩型、营养不良型和肥大型。所有患者均保留钉，行钢板增强，并根据情况行自体骨植骨。所有患者均通过平片检查进行随访，评估功能恢复情况以确定骨愈合情况。
所有 22 例患者均顺利获得术后骨性愈合，平均时间为 22.1 周（12-40 周）。平均手术时间为 105 分钟（60-150 分钟），平均失血量为 340ml（150-700ml）。所有患者均在 3 个月内无疼痛地完全负重行走。无明显并发症，如内固定物断裂、植入物脱出、轴向或旋转对线不良、深部感染等。
保留钉的钢板增强和自体骨植骨可能是治疗股骨干骨折切开复位内固定术后不愈合的一种有效且可靠的方法。
