Lambiris Elias, Panagopoulos Andreas, Zouboulis Panagiotis, Sourgiadaki Efrosini
Department of Orthopaedics, University Hospital of Patras, Greece.
Ipapantis & 25 Martiou 1, Kato Kastritsi, 26504, Patras, Greece.
Eur J Trauma Emerg Surg. 2007 Apr;33(2):120-34. doi: 10.1007/s00068-007-6195-5. Epub 2007 Apr 4.
In spite of increased understanding of biomechanics and improvements of implant design, nonunion of femoral shaft fractures continues to hinder the treatment of these injuries. Femoral nonunion presents a difficult treatment challenge for the surgeon and a formidable personal and economic hardship for the patient. In most series of femoral fractures treated with intramedullary nailing techniques, the incidence of this complication is estimated to be 1%. A higher frequency has recently been reported due to advances in trauma care leading to increased survivorship among severely injured patients and expanded indications of intramedullary nailing. Whereas the treatment of femoral shaft fractures has been extensively described in the orthopedic literature, the data regarding treatment of femoral shaft nonunions are sparse and conflicting, as most of the reported series consisted of a small number of cases. However, careful review of the existing literature does provide some answers regarding either conservative or operative management. The gold standard for femoral shaft nonunions invariably includes surgical intervention in the form of closed reamed intramedullary nailing or exchange nailing, but several alternative methods have been reported including electromagnetic fields, low-intensity ultrasound, extracorporeal shock wave therapy, external fixators and exchange or indirect plate osteosynthesis. In this paper, a comprehensive review of the current treatment modalities for aseptic midshaft femoral nonunion is presented, after a concise overview of the incidence, definition, classification and risk factors of this complication.
尽管对生物力学的理解有所增加，植入物设计也有所改进，但股骨干骨折不愈合仍然阻碍着这些损伤的治疗。股骨干不愈合给外科医生带来了困难的治疗挑战，给患者带来了巨大的个人和经济负担。在大多数采用髓内钉技术治疗的股骨干骨折系列中，这种并发症的发生率估计为1%。由于创伤护理的进展导致重伤患者的存活率提高以及髓内钉适应症的扩大，最近有报道称发生率更高。虽然骨科文献中对股骨干骨折的治疗已有广泛描述，但关于股骨干不愈合治疗的数据却很少且相互矛盾，因为大多数报道的系列病例数量较少。然而，仔细回顾现有文献确实能为保守治疗或手术治疗提供一些答案。股骨干不愈合的金标准始终包括以闭合扩髓髓内钉或更换髓内钉形式的手术干预，但也有报道称有几种替代方法，包括电磁场、低强度超声、体外冲击波疗法、外固定器以及更换或间接钢板接骨术。在简要概述这种并发症的发生率、定义、分类和危险因素之后，本文对无菌性股骨干中段不愈合的当前治疗方式进行了全面综述。
