Treatment of Nonunion of Fracture of the Femoral Shaft

股骨幹骨折不癒合之治療

王榮彬(Jung-Pin Wang) ； 黃俊雄(Chun-Hsiung Huang) ； 蘇榮源(Rong-Yuan Su) ； 賴建宏(Jiann-Horng Lai) ； 劉士嘉(Shyh-Jia Liu)

《Journal of Orthopaedic Surgery Taiwan》 4卷2期 (1987/06) Pp. 47-55

摘要

從民國64年到民國73年本院治療股骨幹骨折不癒合共48例。男性42例，女性6例。48例中6例併發骨髓炎。對無細菌感染之42例其治療是以骨髓內釘( Schneider Nail )固定或緊壓式骨板( DCP )作內固定加上植骨術，結果38例一次開刀後即成功( 90.5% )，經第二次開刀又有3例達到癒合( 97.6% )，併發骨髓瑩整病例在治療上比較困難且較多變化，經腐骨切除及適當抗生素治療後，有4例成功。對本症之治療文獻仍以骨髓內釘固定並加植骨術的成功率最高，即使併發有骨髓炎經適當處理後，此種方法也仍然可行。本院有令人滿意的結果，茲將治療方法及所得結果提出報告加以討論。

並列摘要

A nonunion of a femoral shaft fracture is a unctional and economic catastrophe to the patient. Therefore, it is critical that medical staffs facilitate a quick and successul union that maximizes leg motion and minimizes further complications. With this in mind, the authors began to retrospectively study forty-eight patients with noninfected or infected nonunions of the femoral shaft. In each case, the femoral shaft was treated by rigid internal fixation using either a Schneider nail or a dynamic compression plate adjunctive with a Phemister bone graft. Of the forty-eight patients, forty-two were males. of the 42 noninfected nonunions, 38 or 90.5% of the patients achieved a successful union on the first try. Of the four cases which failed to respond to the corrective surgery, one patient was lost during the followup. Two cases, which were subsequently treated with a larger Schneider nail fixation device and Phemister bone grafts, eventually united. In the fourth case the patient, who experienced a broken dynamic compression plate, was treated by being placed in a cast brace until union occurred. Thus, the final union rate of the noninfected nonunions was 97.6%. The management of the infected nonunions was much more difficult to manage since each case varied in terms of the nature and the extent of the problem. In the six infected cases, one or more sequestrectomies, adequate irrigation, appropriate antibiotics and Phemister bone grafts were the essential components in the successful management and treatment of the nonunions.

並列關鍵字

fracture ； femoral shaft ； nonunion