股骨干骨折钢板内固定术后骨折不愈合临床观察分析.docVIP

股骨干骨折钢板内固定术后骨折不愈合临床观察分析【摘要】 目的 通过临床观察分析股骨干骨折钢板内固定后骨折不愈合的生物力学原因。方法 对2008年6月~2011年4月所收治的50例股骨干骨折钢板内固定术后骨折不愈合病例从临床角度进行生物力学分析。结果 螺钉被放在离骨折处较远位置导致钢板应力增大，是影响骨折愈合的主要因素；钢板长度过短，抗张力能力降低，是影响骨折愈合的重要因素；由于粉碎骨折骨连接没有在骨折区实现，作用在钢板上的压力会因为作用长度的增加而导致钢板断裂进而影响骨折愈合；螺丝的数目不足是骨折端不稳定重要因素；钢板置于压力侧易发生断裂，进而引起不稳定；当压力侧的骨皮质产生缺损，钢板将要负荷较高的弯曲应力而断裂，同时引起骨折端不稳定。结论 股骨干骨折钢板内固定后骨折不愈合原因很多，其中螺钉位置不当、钢板长度过短、粉碎性骨折是三个重要原因。? 【关键词】 股骨干； 骨折； 钢板固定； 生物力学?? Clinical observation and analysis on the nonunion in original position after internal fixation with plate in femoral shaft fractue ?HAN Yue-qi,SONG Jing-lun,WANG Jun-jiang,et al.Jizhong Energy Xingtai Mining Group General Hosspital,Xingtai 054000,China?? 【Abstract】 Objective To analyze the reasons of Femoral Shaft fracture of nonunion in original position after internal fixation.Methods 50 cases of Femoral Shaft fracture of nonunion in original position after internal fixation were analyzed from the view point of clinic and biomechanics.Results The plate strain was increscent with screws placed away from the gap or spaced apart.The plate was too short to stand the tension force.Because of comminuted fracture and no synostosis,the plate strain was increscent as the plate length was prolonged and support bigger tension force.The insufficiency of the number of screws affected the stability of bone break.The plate which was in the pressure side of tibiofibula can break easily.Lack of cortical bone in the pressure side of tibiofibula,the plate break refracture were easy as its bending strain was higher.Conclusion There were much reasons for femoral Shaft fracture of nonunion in original position after internal fixation,and the poor location of the screws,the short plate and the comminuted fracture were the most important reasons.? 【Key words】 Femoral Shaft； Fracture； Plate fixation； Biomechanics ?? 钢板内固定是治疗股骨干骨折的常用方法之一，为骨折的修复和关节功能迅速恢复提供一个良好的生物学和力学环境。然而，在长期的临床实践中也发现了一些问题。其中，骨折不愈合或迟延愈合是突出的问题之一。如何改进技术及固定方法，预防和避免这种问题的发生，是钢板内固定治疗股骨干骨折期待解决的问题之一。笔者对2008年6?月~?201