Jiang Ying, Guo Yong-Fei, Meng Ya-Ke, Zhu Lei, Chen Ai-Ming
Department of Medicine, New Jersey Medical School Affiliated to Rutgers University, Newark, NJ 07103, United States; Department of Neurosurgery, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
Injury. 2016 Oct;47(10):2307-2311. doi: 10.1016/j.injury.2016.07.026. Epub 2016 Jul 20.
The refractory post-operative diaphyseal femur fracture (DFF) non-union is extremely difficult to treat and remains severe challenges for orthopedists. Although several traditional internal fixations and novel biomedical techniques have been used in managing this complication, its treatment is still fraught with severe challenges.
Starting from 1999, 5 patients after three previous internal fixation operations showing refractory DFF non-union underwent the comprehensive fibular autograft with double metal locking plates fixation (cFALP) surgery. The autogenous fibular was first harvested and non-evenly split into two halves in a longitudinal manner. After retracting all previous internal fixation(s), the larger half strut fibula was hammered into the femur canal while the smaller half was fragmented into small pieces and filled surrounding the DFF site. Two locking compression plate were fixed on the lateral and anterior (or antero-lateral) side of the femur, respectively.
The follow-up ranged from 60 to 96 weeks. All cases (100%) achieved bony union without severe complications. The mean time to union was 36±14.7 weeks (range 24-60 weeks).
The cFALP is a promising surgical modality for DFF non-union treatment. However, because fibular harvest may cause severe complications, the cFLAP should only be considered in refractory DFF non-union cases.
难治性股骨干骨折（DFF）术后骨不连极难治疗，仍然是骨科医生面临的严峻挑战。尽管几种传统内固定方法和新型生物医学技术已用于处理这一并发症，但其治疗仍充满严峻挑战。
自1999年起，5例先前接受过3次内固定手术且显示难治性DFF骨不连的患者接受了带双金属锁定钢板固定的自体腓骨综合移植术（cFALP）。首先切取自体腓骨并纵向不均匀地劈成两半。拆除所有先前的内固定后，将较大的半侧支撑腓骨锤入股骨髓腔，而较小的半侧则破碎成小块并填充在DFF部位周围。两块锁定加压钢板分别固定在股骨的外侧和前侧（或前外侧）。
随访时间为60至96周。所有病例（100%）均实现骨愈合，无严重并发症。平均愈合时间为36±14.7周（范围24 - 60周）。
cFALP是一种有前景的治疗DFF骨不连的手术方式。然而，由于切取腓骨可能会引起严重并发症，cFLAP仅应在难治性DFF骨不连病例中考虑使用。
