中国修复重建外科杂志

中国修复重建外科杂志

股骨干无菌性骨不连的最新治疗进展

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目的 对股骨干无菌性骨不连的最新治疗进展进行综述。 方法 广泛查阅近年国内外有关股骨干无菌性骨不连治疗的临床研究结果,并进行总结。 结果 股骨干无菌性骨不连的治疗方式主要有以下几种。髓内钉动力化应慎重选择,其临床预后不确定。更换髓内钉适合于股骨干峡部的肥大型骨不连。更换外侧钢板适用于合并明显畸形的骨不连患者。但当合并明显内侧缺损时,应采用波形钢板或双钢板。附加钢板提高了髓内钉治疗骨不连的成功率,但对畸形或骨缺损明显的患者应慎重选择。Ilizarov 牵张成骨技术适用于各种情况的骨不连,尤其是合并复杂畸形或大段骨缺损者。膜诱导技术也是治疗骨不连伴大段骨缺损的重要手段。阻挡钉技术的有效性还有待进一步证据支持。生物学刺激物多用于萎缩型骨不连,单独使用的临床效果仍存在争议。 结论 由于缺乏不同手术方式之间的对照研究,临床实践应根据患者情况和骨不连类型,选择合适的治疗方案。

Objective To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.

关键词: 股骨干无菌性骨不连; 手术治疗; 髓内钉; 钢板; 生物学刺激

Key words: Aseptic femoral shaft nonunion; surgical treatment; intramedullary nail; plate; biological stimulants

引用本文: 张伟, 陈华, 唐佩福. 股骨干无菌性骨不连的最新治疗进展. 中国修复重建外科杂志, 2018, 32(5): 519-525. doi: 10.7507/1002-1892.201712089 复制

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