股骨粗隆间骨折术后骨不连的治疗现状

Current treatment for nonunion of femoral intertrochanteric fractures

摘要:

股骨粗隆间骨折术后骨不连是一种少见而严重的并发症。手术治疗是主要的临床选择。手术方案包括保留股骨头和髋关节置换两大类，前者包括股骨粗隆外翻截骨术和更换内固定术，后者包括全髋和半髋关节置换术。选择治疗方案需考虑多种因素，尤其是首次内固定治疗失败一定程度上破坏了股骨近端结构，这都增加了治疗难度。本文总结了近年来国内外股骨粗隆间骨折术后骨不连的治疗策略、治疗手段及其治疗指征，为临床上股骨粗隆间骨折术后骨不连的诊断、治疗提供参考。

Abstract:

Nonunion of femoral intertrochanteric fractures secondary to surgical treatment is a rare but serious complication. Revision surgical treatment is the main clinical option, involving femoral head preservation and hip arthroplasty. The former includes valgus osteoto- my and replacement of internal fixation, and the latter includes total hip arthroplasty and hemiarthroplasty. Many factors must be consid- ered in the choice of treatment, especially the failure of the previous internal fixation with proximal femur loss in some extent, which in- creases the difficulty of the revision surgery. This paper summarized the treatment strategies, techniques and indications for postoperative nonunion of femoral intertrochanteric fractures at home and abroad in recent years, providing reference for the diagnosis and treatment of this dilemma in clinical setting.