摘要
背景:骨不连是骨折治疗中常见的并发症。引起股骨干骨折骨不连的原因和机制非常复杂,原因有手术操作不当、内固定材料选材不当、复位不正确或粉碎性骨折随意遗弃骨碎块、术后功能锻炼不当等。目前对股骨干骨折术后骨不连修复方式的选择仍存争议。目的:分析双钢板固定联合颗粒植骨修复股骨干骨折术后骨不连的临床效果。方法:自2010年6月至2012年8月应用双钢板加颗粒植骨修复非感染性股骨干骨折术后骨不连患者14例,男9例,女5例;年龄22-49岁,平均36.2岁;其中多次内固定(包括钢板、髓内钉及髓内钉动力化)失败9例,初次内固定(钢板固定或髓内钉固定)后骨不连接5例。根据Judet分类法分型:肥大型8例,萎缩性6例。骨不连病程11-46个月,平均26.2个月。术后定期随访,观察双钢板固定联合植骨对股骨干骨折术后骨不连的修复效果。结果与结论:全部患者随访10-25个月,骨不连均在4-7个月骨性愈合,平均愈合时间5.2个月。无切口感染,内固定物松动及断裂等并发症。双钢板固定联合颗粒植骨具有三维立体固定,稳定性强,可充分髓内植骨等特点,符合骨折愈合所需要的力学环境,操作简便,术中软组织与骨膜剥离及血运破坏适当,术后并发症少。提示双钢板固定联合颗粒植骨能有效修复股骨干骨折术后骨不连。
BACKGROUND： Nonunion is a common complication of fractures. Reasons and mechanisms of causing femoral shaft nonunion are very complex. The reasons are improper surgical procedures, improper fixation material selection, incorrect reset or arbitrary abandonment of bone fragments after comminuted fracture, and improper postoperative functional exercise. It is still controversial to choose a repair method for nonunion after femoral shaft fracture surgery. OBJECTIVE： To analyze the clinical results of double plate fixation and bone grafting for repair of nonunion after femoral shaft fracture. METHODS： From June 2010 to August 2012, 14 cases of noninfectious nonunion of femur were treated with bone grafting and double plates. There were 9 males and 5 females, mean age of 36.2 years （range 22 to 49 years）. The nonunion had resulted from failure of more than once internal fixation in 9 cases, including plates, intramedullary nails and nail dynamization, as well as failure of once internal fixation （plate fixation or intramedullary nailing fixation） in 5 cases. According to the Judet classification, there were 8 cases of hypertrophic nonunion and 6 cases of atrophic nonunion. The history of nonunion lasted from 11 to 46 months, mean 26.2 months. During postoperative regular follow-up, the clinical results of double plate fixation and bone grafting for repair of nonunion after femoral shaft fracture were observed. RESULTS AND CONCLUSION： All patients were followed up for 10 to 25 months. All cases healed after a mean duration 5.2 months （range 4-7 months）, without wound infection, fixation loosening or breakage. Due to three-dimensional fixation, strong stability and fully bone graft, double plate fixation and bone grafting are in line with the required mechanical fracture healing environment, and simple to be operated. Intraoperative soft tissue and periosteal stripping and blood supply damage are adequate, with less complication. These results confirmed that double plate fixation and bone grafting can effectively repair nonunion after femoral shaft fracture.
出处
《中国组织工程研究》
CAS
CSCD
2014年第53期8607-8611,共5页
Chinese Journal of Tissue Engineering Research
