Cove J A, Lhowe D W, Jupiter J B, Siliski J M
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114, USA.
J Orthop Trauma. 1997 Oct;11(7):513-20. doi: 10.1097/00005131-199710000-00009.
To assess the efficacy of treatment and develop an algorithm for management of nonunions of the femoral diaphysis.
Retrospective.
University hospital.
Forty-four patients treated at one institution for nonunion of the femoral diaphysis were studied. Thirteen of these patients had a history of infection. After debridement (where appropriate) and repair of the femoral nonunion, follow-up averaged twenty-eight months (range, 24 to 108 months). All patients were examined at final follow-up.
Thirty-three patients achieved union after one procedure, and eight patients achieved union after additional procedures. One patient underwent above-knee amputation, and two patients remained ununited at the time of their final follow-up. Time to union averaged 11.8 months. Seventeen patients healed with more than two centimeters of shortening, and ten patients lost more than 30 degrees of knee flexion.
Established femoral diaphyseal nonunions can be treated effectively, even in the presence of chronic sepsis. Selective use of a vascularized fibula transfer has proven beneficial in addressing intercalary defects. Plate fixation, with or without a vascularized fibula transfer, has been the predominant mode of skeletal stabilization in more complex reconstructions.
评估治疗股骨干骨不连的疗效，并制定股骨干骨不连的治疗方案。
回顾性研究。
大学医院。
对在一家机构接受治疗的44例股骨干骨不连患者进行研究。其中13例患者有感染史。在对股骨干骨不连进行清创（如适用）和修复后，随访时间平均为28个月（范围为24至108个月）。所有患者均在最终随访时接受检查。
33例患者一次手术后实现骨愈合，8例患者经额外手术后实现骨愈合。1例患者接受了膝上截肢术，2例患者在最终随访时仍未愈合。骨愈合时间平均为11.8个月。17例患者愈合后短缩超过2厘米，10例患者膝关节屈曲丧失超过30度。
即使存在慢性脓毒症，已确诊的股骨干骨不连也能得到有效治疗。选择性使用带血管腓骨移植已被证明有助于解决节段性骨缺损。在更复杂的重建手术中，钢板固定，无论是否联合带血管腓骨移植，一直是主要的骨骼稳定方式。
