Wu C C
Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
J Trauma. 1997 Aug;43(2):263-7. doi: 10.1097/00005373-199708000-00010.
The aim of this retrospective study was to investigate the effect of dynamizing a static interlocking nail to promote femoral fracture healing and the adverse effect of dynamization.
Twenty-eight static femoral interlocking nails were dynamized after 4 months (median, 6 months; range, 4-12 months) because of poor fracture healing. The clinical and roentgenographic healing processes were recorded. Significant complications were treated and analyzed.
Twenty-four patients were followed for at least one year (median, 32 months; range, 13-49 months). Fourteen patients (58%) achieved a solid union with a union period of 5.2 +/- 2.0 months after dynamization. Twenty-one percent of patients (5 of 24) had more than 2 cm of femoral shortening; all occurred in cases of nonunion (p < 0.01, Fisher's exact test). All 10 cases of nonunion were treated with cancellous bone grafting with or without lengthening and achieved satisfactory outcomes.
Dynamization is a method that can be tried to improve fracture healing in femoral fractures that show delayed healing after interlocking nailing. In my experience, however, not all cases achieve union after dynamization. Patients must be examined regularly after dynamization to avoid significant shortening.
本回顾性研究旨在探讨动力化静态交锁髓内钉促进股骨骨折愈合的效果及动力化的不良反应。
28枚静态股骨交锁髓内钉因骨折愈合不佳在4个月后（中位数为6个月；范围为4 - 12个月）进行了动力化处理。记录临床和影像学愈合过程。对显著并发症进行治疗和分析。
24例患者至少随访1年（中位数为32个月；范围为13 - 49个月）。14例患者（58%）实现了牢固愈合，动力化后愈合时间为5.2±2.0个月。21%的患者（24例中的5例）股骨短缩超过2 cm；均发生在骨不连病例中（p < 0.01，Fisher精确检验）。所有10例骨不连病例均采用松质骨移植治疗，部分病例进行了延长，取得了满意的结果。
动力化是一种可尝试用于改善交锁髓内钉固定后愈合延迟的股骨骨折愈合的方法。然而，根据我的经验，并非所有病例在动力化后都能实现愈合。动力化后必须定期检查患者，以避免明显短缩。
