锁定加压接骨板与交锁髓内钉治疗股骨无菌性骨不连的疗效比较

摘要

目的 探讨锁定加压接骨板(locking compression plate, LCP)与交锁髓内钉(intramedullary interlocking nail, IIN)固定治疗股骨无菌性骨不连的临床疗效.方法 回顾性分析2004年1月-2014年12月手术治疗的36例股骨骨不连的临床资料,其中LCP组15例,IIN组21例,并对两组骨愈合情况及下肢功能情况分别进行了ASAMI评分.结果 术后36例均获得随访,随访时间9~20个月,平均15个月,截至最后一次随访,LCP组全部获得骨性愈合,愈合时间6.1~10.5个月,平均6.8个月.未发现螺钉及钢板松动断裂及感染等并发症,ASAMI评分骨评价结果优良率为86.6%,关节功能评价结果优良率为93.3%;IIN组愈合时间5.7~13个月,平均7.8个月.术后无感染并发症,骨评价结果优良率为95.2%,关节功能评价结果优良率为85.7%,有1例锁钉断裂未愈合,取出髓内钉更换LCP加植骨术后10个月愈合.结论 LCP和IIN都是治疗股骨干骨折骨不连的有效方法,因为股骨无菌性骨不连发生的原因复杂,表现各异,在股骨骨不连的治疗中我们要有针对性地纠正其造成骨不连的不利因素,区别对待.对于股骨峡部的肥大型骨不连应首选更换髓内钉治疗.对于股骨干/干骺端的骨不连,以及骨不连合并严重骨质疏松的患者LCP是更为合适的选择.%Objective To explore the effect of locking compression plate (LCP) and intramedullary interlocking nail (IIN) in the treatment of femur Shaft Fracture nonunion. Methods From January 2005 to December 2014 in The 252 Hospital of PLA, 15 cases of femur nonunion were treated with LCP, 21 were treated with IIN. A retrospective study was performed to compare the outcomes of LCP and IIN by analyzing ASAMI scores of fracture healing and function of lower limb. Results Thirty six cases were fellowed up successfully with a mean period of 15(9-20)months. There was no infection, no incidence of implant failure. bone union was achieved in all the LCP cases, with the mean healing period of 6.8 months (ranged from 6.1-10.5 months)in the LCP cases. According to ASAMI bone union scoring, excellent in 11 cases, good in 2, fair in 2 and poor in 0. The excellent and good result rate was 86.6% in the LCP cases.According to ASAMI function scoring,excellent in 12 cases,good in 2, fair in 1 and poor in 0. The excellent and good result rate was 93.3% in all the LCP cases. Ranged from 6.1-10.5 months (average 11) cases,good in 2, fair in 2 and poor in 0. The excellent and good result rate was 86.6% in the LCP cases. With the mean healing period of 7.8 months (ranged from 5.7-13 months)in the IIN cases. According to ASAMI bone union scoring, excellent in 16 cases,good in 2, fair in 2 and poor in 1. The excellent and good result rate was 95.2% in the IIN cases. According to ASAMI function scoring, excellent in 16 cases, good in 2, fair in 2 and poor in 1. The excellent and good result rate was 85.7% in all the IIN cases. There wes no infection in the IIN cases. There was 1 nonunion case in the IIN cases. Conclusion LCP and IIN can all be used effectively for treatment of femur nonunion. In the metaphyseal- diaphysealarea, the intramedullary canal is too wide to provide stability with an Intrame-dullary device, and the cortical bone is thinning out, providing insufficient bone for stable cortical fixation. For metaphyseal-diaphyseal and osteoporotic nonunion, it is an ideal choice to use LCP. IIN is a good choice for the isthmic portion area nonunion.