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題 名 | Aseptic Nonunion of a Femoral Shaft Treated Using Exchange Nailing=更換骨髓內釘治療股骨幹非感染性不癒合之研究 |
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作 者 | 游家偉; 吳基銓; 陳文哲; | 書刊名 | 長庚醫學 |
卷 期 | 25:9 2002.09[民91.09] |
頁 次 | 頁591-598 |
分類號 | 416.26 |
關鍵詞 | 股骨幹; 更換骨髓內釘; 非感染性不癒合; Femoral shaft; Exchange nailing; Aseptic nonunion; |
語 文 | 英文(English) |
中文摘要 | 背景:雖然治療股骨幹非感染性不癒合的方法有許多種,更換骨髓內釘仍然被認為是最簡單的手術法。然而,癒合的成功率在不同的研究計畫中仍有相當的差異,本研究採取更換骨髓內釘於治癒股骨幹非感染性不癒合,評估其臨床追蹤結果,以更進一步確立其所扮演之角色。 方法:從1994年10月至1999年12月,39位患有股骨幹非感染性不癒合之患者(其中一位為兩側股骨幹不癒合)接受此項手術法治療。手術之適應症為:股骨幹非感染性不癒合、已接受骨髓內釘固定、股骨縮短小於1公分、X光檢查於不癒合處顯示放射線透過性、並且無間段式骨骼缺損。手術方式包括:拔除原有之骨髓內釘、骨髓內腔擴大鑽孔、以及重新置放較穩定之骨髓內釘。 結果:這些患者接受手術治療之後,有35位病患(包括一例兩側疾患)接受臨床追蹤至少壹年(正中期2.9年,分布範圍1.1到6.0年);其中有32位病患之股骨順利地癒合(包括一例兩側疾患),癒合率為91.7%(33/36),癒合的正中期為4個月(分布範圍3至8個月),並且沒有產生任何嚴重的手術併發症。另外三位股骨持續不癒合之病患,目前仍繼續接受臨床追蹤,尚未接受進一步手術治療。 結論: 在本研究中採用更換骨髓內釘手術法用於治療股骨幹非感染性不癒合,雖然手術技術相對來說較簡單,但是依舊可以達成很高的癒合率,而產生手術併發症的機率亦相當低;雖然造成持續不癒合的因素仍然不明,但是,臨床上,對於符合上述手術適應症之患者,更換骨髓內釘手術法應被接受為治療股骨幹非感染性不癒合之優先選擇。 |
英文摘要 | .Background: There are many methods for treating femoral shaft asepic nonunions of which exchange nailing is the simplest technique. However, the reported success rate varies. Therefore, a prospective study was conducted to further clarify the role of exchange nailing. Methods: From October 1994 through December 1999, 40 femoral shaft aseptic nonunions in 39 patients were treated using exchange nailing. The indications for this technique included a femoral shaft aseptic nonunion with a previously inserted intramedullary nail, less than 1 cm shortening, a radiolucent line of the nonunion, and no segmental bony defects. The surgical technique consisted of close removal of the previously inserted intramedullary nail, reaming the intramedullary canal as widely as possible (1 or 2 mm oversized), and re-insertion of a stable unlocked or locked intramedullary nail. Results: Thirt-six femoral shaft aseptic nonunions in 35 patients were followed-up for at least 1 year (median, 2.9 years; range, 1.1~6.0years) and 33 nonunions healed. The union rate was 91.7% (33/36) and the union period was median 4 months (range, 3~8months). No major surgical complications were noted. The other three patients with persistent nonunions were continuously followed-up due to their reluctance for further operations. Conclusion: Although exchange nailing is a relatively simple surgical technique, it can still achieve a high union rate with a low complication rate. Despite that factors to induce a persistent nonunion are still unclear, clinically, exchange nailing should be used as the first choice in the treatment of an indicated femoral shaft aseptic nonunion. |
本系統中英文摘要資訊取自各篇刊載內容。