| Objective:The femur is the long tubular bone of the lower limbs.With the rapid development of the modern economy and the changes in people's production and lifestyle,the femoral shaft fracture caused by high-energy violence such as falling from heights and car accidents are gradually becoming more and more.The incidence of delayed healing and even nonunion after femoral shaft surgery has also increased.The factors such as the severity of trauma or the limitation of regional medical conditions have led to an increase in the incidence of delayed healing and even nonunion after femoral shaft surgery.Local anatomical factors,systemic factors,infection and iatrogenic factors can cause delayed union and nonunion of the bone.The delayed healing of the femoral shaft after interlocking intramedullary nailing has been proposed by some scholars in recent years.The locked nail is removed from one side to make the static fixation into a dynamic fixation method to promote fracture healing,that is,the intramedullary nail dynamization.However,the treatment is axial compression,which promotes fracture healing.The stability of the side the rotation and side of the fracture is relatively decreased,and some patients even bear limb shortening and intramedullary nail fracture.The best timing for dynamization treatment is also different,and there is some controversy.In order to explore the effect and influence of the timing and methods of dynamization treatment on fracture healing,this study collected the case data,imaging data and functional prognosis of non-infectious delayed healing after interlocking intramedullary nailing of femoral shaft fractures,followed up and statistics.To analyze the factors affecting delayed union after femoral shaft fracture,and to analyze the clinical efficacy and precautions of postoperative treatment of delayed union and nonunion of femoral shaft fractures with intramedullary nailing,and expect to give clinical work some guidance and help.Methods:This study selected 50 patients with delayed union after treatment of femoral shaft fractures with the use of interlocking intramedullary nail in Department of Orthopaedics,Xijing Hospital,Air Force Military Medical University(formerly the Fourth Military Medical University)from February 2010 to September 2018,including 29 patients treated with dynamization and 21 patients received non-dynamization technique for non-infectious delayed union of femoral shaft fracture after interlocking intramedullary nailing.All patients met the inclusion criteria and were included in the study with informed consent and informed consent.Divided into two groups according to the treatment method.Case inclusion criteria:Dynamization group(1)Closed or open reduction and interlocking intramedullary nail internal fixation for femoral shaft fracture was performed in our hospital or outpatient hospital for the first time.And were treated with dynamization in our hospital.(2)Diagnosis consistent with delayed union.(3)None of the patients had received any other treatment for six months before and after the follow-up.Non-dynamization group(1)The first operation of interlocking intramedullary nail internal fixation for femoral shaft fracture was performed in our hospital or outpatient hospital.The follow-up results showed that the fracture healed delayed,and the healing was followed up.(2)Diagnosis consistent with delayed union.Case exclusion criteria:(1)Infectious nonunion,pathological fracture or suffering from metabolic bone disease.(2)Patients with bone fractures with other fractures or multiple fractures of the femoral shaft need to be(or need to be combined)other methods of internal fixation and external fixation.(3)Patients with vascular nerve injury.(4)Under 16 years old and over 60 years old,or with severe visceral diseases,diabetes,tumors,etc.(5)Have received other treatments.Intramedullary nail dynamic treatment of 29 patients(dynamization group),gender: 17 males and 12 females;aged 24 to 52 years,mean(35.15 ± 5.53)years old;causes of injury: 16 cases of car accidents,high places There were 7 cases of fall injury and 6 cases of heavy bruises;13 cases on the left side,15 cases on the right side and 1 case on both sides.The fractures were classified by AO,including 3 cases of A1.2 type,8 cases of A2.2 type,7 cases of A2.3 type,4 cases of A3.2 type,6 cases of B 2.2 type and 1 case of C type.All patients were simple type fractures,and static interlocking intramedullary nails were used for the first treatment.Of the 29 patients,19 were treated with dynamization(early dynamization)within 6 months after the first postoperative period,10 were treated with dynamization for more than 6 months(late dynamization);only 13 of the dynamized were removed with static lock.Nail,but still retains the power lock nail(partially dynamization),and 16 cases remove all locking nails(fully dynamization).There were 21 non-motorized patients(non-dynamization group),14 males and 7 females;aged 28-56 years,mean(37.34 ± 6.82)years old.8 cases on the left and 13 cases on the right.The fractures were classified by AO,including A1.2 in 2 cases,A2.2 in 4 cases,A2.3 in 2 cases,A3.2 in 2 cases,B2.2 in 8 cases,and C in 3 cases.The dynamic group was reexamined 1.5 months,3 months and 6 months after operation,while the non-dynamic group was reexamined every two months according to the individual fracture healing.According to the clinical healing standard of fracture and the Fernadezesteve imaging evaluation standard,the clinical healing time,imaging bone fracture score and complications were recorded.According to the knee Lysholm score and the hip Harris score,the knee and hip function scores were scored for each follow-up patient.Results:The 50 patients were followed up for 10 to 28 months with an average of(16.35±2.13)months.The patients in the dynamization group got bony healing significantly earlier than those in the non-dynamization[(8.68±1.97)months versus(10.44±2.12)months,P<0.05].Of the 29 patients in the dynamization group,the patients in the early dynamization subgroup had significantly higher bone-union rate than those in the late dynamization subgroup[86.73% versus 33.33%,P<0.05].On the other aspect,the patients in the partial dynamization subgroup got significantly higher bone-union rate than those in the complete dynamization subgroup [ 92.30% versus 62.50%,P<0.05 ].There was no significant difference in Harris score between the two groups(t = 1.951,P > 0.05).Lysholm score of knee joint in dynamic group was higher than that in non-dynamic group(t = 4.567,P < 0.05).There was significant difference between the two groups.The recovery of knee joint function in dynamic group was better than that in non-dynamic group.Conclusion:For non-infectious delayed union of femoral shaft fractures after interlocking intramedullary nailing operation,dynamization of the nail does considerably can promote fracture union,the early dynamization is better than the late dynamization and the partial dynamization is superior to the complete dynamization... |
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