大腿骨偽関節の治療経験

Abstract

Eight cases with femoral non-union followed up for more than six months are reported. In four cases of non-union without infection, a plate or intramedullary rod was used to stabilize the femur and iliac bone grafting averaging 2.7cm was used to bridge the femoral defect after resecting sclerotic bone. In four infectious cases of non-union, segmental bone resection was done as a first stage surgery under external fixation of the femur in order to eliminate chronic femoral osteomyelitis. After four to six months following the first stage surgery, and after confirming the absence of infection, vascularized fibula graft (VFG) averaging 7cm was used to bridge the bone defect. In all cases without infection, primary femoral union was achieved within three months. Two cases of non-union treated with dual plating which enabled early knee joint motion by CPM achieved a satisfactory range of motion (0/125, 0/110 respectively). In the cases with infections non-union, recurrence of osteomyelitis was not seen. Three cases achieved primary bone union and the remaining case achieved union after additional bone grafting. In two cases treated with folded VFG earlier bone union and slightly better knee motion was achieved in comparison to those treated with single VFG.