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目的：评价扩髓更换髓内钉治疗髓内钉固定后股骨干肥大性骨不连的临床疗效及手术适应症。方法：自1998 年4 月至2009 年6 月采用扩髓更换髓内钉治疗11 例髓内钉固定后股骨干肥大性骨不连，其中男9 例，女2 例，年龄23-61 岁。平均36.2 岁，骨折部位在股骨上1/3 者2 例；中1/3 者6 例；下1/3 者3 例，原始骨折Winquist-Hansen 分型：I 型2 例，II 型3 例，III 型4 例, IV 型2 例。结果：11 例患者均获随访，时间：11～56 个月，平均27.4 个月，2 例患肢短缩1 cm。另4 例未获得骨性愈合，3 例再次采用附加钢板合并自体髂骨植骨，1 例远端锁钉动力化，再次干预后获得骨性愈合，愈合时间6～16 个月，平均8.3 个月。结论：扩髓更换髓内钉是治疗髓内钉固定后股骨肥大性骨不连的传统方法，基于力学稳定和临床观察，更适用于股骨中段骨不连。

英文摘要:

Objective: Evaluation of reamed intramedullary nailing for the treatment of replacement after intramedullary nailing of femoral stem hypertrophic nonunion of the clinical curative effect and the operation indications. Methods: From 1998 April to 2009 June using reamed intramedullary nailing in the treatment of 11 cases of replacement after intramedullary nailing of femoral stem hypertrophic nonunion. There were 9 male, 2 female, age 23-61 years old. An average of 36.2 years, the fracture site in the femur on 1 / 3 in 2 cases; in 6 cases 1 / 3; 1 / 3 in 3 cases. The original fracture Winquist - Hansen type: type I in 2 cases, II 3 cases, III 4 cases, IV 2 cases. Results: 11 patients were followed up, time: 11 to 56 months, an average of 27.4 months, 2 cases of limb shortening in 1 cm. Another 4 patients did not obtain bony healing. In 3 cases the additional plate again with autologous iliac bone graft, 1 cases of distal locking nail dynamization, again after the intervention to obtain bony healing, healing time of 6 -16 months, mean 8.3 months. Conclusion: Reamed intramedullary nailing is the replacement treatment after intramedullary nailing of femoral hypertrophic nonunion by traditional methods, based on the mechanical stability and clinical observations, more suitable for femoral nonunion.

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