Matelic T M, Monroe M T, Mast J W
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
J Orthop Trauma. 1996;10(1):1-6. doi: 10.1097/00005131-199601000-00001.
Seven patients, with an average age of 53 years, were treated for bone loss or recalcitrant nonunions of the femur. The average duration from initial injury to presentation was 37 months (range 4-92 months). The patients had undergone one to eight (mean, 3.9) previous surgical attempts at achieving union. The nonunion involved the diaphysis in three patients, the diaphyseal-supracondylar junction in three patients, and the pertrochanteric region in one patient. All patients were treated using a standard lateral plate in combination with an endosteal plate and primary iliac crest bone grafting. The mean surgical time was 6.3 h, and the average blood loss was 1.7 L. There were three complications, including one superficial wound infection, one nonfatal pulmonary embolism, and one wound hematoma. At a mean follow-up of 12.6 months (range 4-24 months), all fractures had healed with an average time to union of 19.2 weeks (range 15-36 weeks). Knee flexion averaged 118 degrees (range 100-135 degrees), and all patients were satisfied with the operative procedure. Endosteal plating, in combination with a standard lateral plate and iliac crest bone-grafting, can successfully treat difficult nonunions of the femur.
7例平均年龄53岁的患者因股骨骨质流失或顽固性骨不连接受治疗。从初次受伤到就诊的平均时间为37个月（范围4 - 92个月）。这些患者此前为实现骨愈合已接受过1至8次（平均3.9次）手术尝试。骨不连发生于3例患者的骨干、3例患者的骨干 - 髁上交界处以及1例患者的转子周围区域。所有患者均采用标准外侧钢板联合骨内膜钢板及自体髂骨植骨进行治疗。平均手术时间为6.3小时，平均失血量为1.7升。出现了3例并发症，包括1例表浅伤口感染、1例非致命性肺栓塞和1例伤口血肿。平均随访12.6个月（范围4 - 24个月）时，所有骨折均已愈合，平均愈合时间为19.2周（范围15 - 36周）。膝关节平均屈曲角度为118度（范围100 - 135度），所有患者对手术过程均满意。骨内膜钢板联合标准外侧钢板及髂骨植骨能够成功治疗股骨难治性骨不连。
