目的

观察评价新型组合式锁定钢板治疗股骨髓内钉术后骨不连的疗效。

方法

将22例股骨髓内钉术后骨不连患者根据治疗方式不同分为观察组和对照组；观察组11例采用新型组合式锁定钢板（NALCP）固定治疗，对照组11例采用锁定加压钢板（LCP）治疗。记录置入螺钉数量、螺钉固定皮质层数、术中出血量、骨折愈合时间、术后第1、3、6个月下肢功能评分、术后1月视觉模拟评分法（VAS）、末次膝关节HSS评分、髋关节Harris评分评价疗效。两组不同时间点比较使用重复测量方差分析，然后采用Bonferroni多重比较；两组间比较计量资料采用独立样本t检验，计数资料比较采用确切概率法检验。

结果

术后第1、3、6个月、1年进行随访。观察组中的置入螺钉、螺钉固定皮质层数量均多于对照组，两者比较差异具有统计学意义（t=19.030、12.245，均为P<0.001），术中出血量（t=-10.564）、骨折愈合时间（t=-30.869）观察组均少（短）于对照组（均为P<0.001）。术后第1、3、6个月观察组下肢功能评分均高于对照组（t=27.111、61.968、9.553，均为P<0.001）；术后1个月VAS评分观察组均低于对照组（t=-6.847，P<0.001），两组末次膝关节HSS评分及髋关节Harris评分差异均无统计学意义（t=1.580、0.830，均为P>0.05）。

结论

在保留原有髓内钉的基础上，与LCP相比，使用NALCP作为附加钢板治疗股骨髓内钉术后骨不连可以有效增强断端的稳定性，保护局部血供，减少手术创伤，骨折断端愈合速度更快，改善患者下肢功能恢复和降低患者疼痛，生活质量更佳。

Objective

To evaluate the clinical efficacy of a new assembly locking compression plate in the treatment of femoral nonunion after intramedullary nailing.

Methods

Twenty-two patients with nonunion following femoral intramedullary nailing surgery were divided into an observation group and a control group according to different treatment approaches.In the observation group, 11 cases were treated with the new assembly locking compression plate (NALCP) fixation, while 11 cases in the control group received treatment with the locking compression plate (LCP).The following parameters were recorded and compared: number of inserted screws, cortical fixation layers achieved by screws, intraoperative blood loss, fracture healing time,lower limb function scores (assessed at one, three, and six months postoperatively), visual analog scale (VAS)scores at one month after operation, final Hospital for Special Surgery (HSS) knee scores, and Harris hip scores(HHS) to evaluate clinical outcomes.Statistical analyses were performed as follows: comparisons across different time points between the two groups were analyzed using repeated measures ANOVA followed by Bonferroni post hoc test; comparisons of continuous data between groups was conducted by independen t test, while categorical data were assessed using Fisher’s exact test.

Results

Patients were followed up postoperatively at one, three,and six months, and one year.The observation group demonstrated a greater number of inserted screws (t=19.030,P<0.001) and cortical fixation layers achieved by screws (t=12.245, P<0.001) compared to the control group,with both differences reaching statistical significance.The observation group exhibited less intraoperative blood loss (t=-10.564, P<0.001) and shorter fracture healing time (t=-30.869, P<0.001) compared to the control group.Compared to the control group, the observation group showed higher lower limb function scores at one, three, and six months after operation (t=27.111, 61.968, 9.553, all P<0.001).The observation group exhibited lower VAS scores at one month after operation compared to the control group (t=-6.847, P<0.001).No statistically significant differences were observed between the two groups in the final HSS knee scores or HHS (t=1.580, 0.830, all P>0.05).

Conclusions

Compared to LCP, NALCP as an adjunctive fixation for femoral nonunion following intramedullary nailing demonstrates superior clinical efficacy.By retaining the original intramedullary nail, NALCP provides enhanced fracture stability through multi-dimensional fixation while preserving local blood supply due to its anatomical design.This approach minimizes surgical trauma,accelerates fracture union, improves lower limb functional recovery, reduces early postoperative pain, and enhances patients’ quality of life.