摘要
目的探讨保留原有髓内针附加钢板固定加植骨治疗带锁髓内针术后旋转不稳定性骨折不愈合的临床疗效。方法 23例带锁髓内针术后旋转不稳定性骨折不愈合患者,男20例,女3例,年龄21～63岁,平均33.7岁。骨折部位:股骨干16例,胫骨干4例,肱骨干3例。初次手术为闭合复位带锁髓内针固定15例,切开复位带锁髓内针固定8例。骨折不愈合的时间为带锁髓内针固定术后9～38个月,平均17个月。X线示肥大性骨折不愈合14例,萎缩性骨折不愈合9例。均采用保留髓内针附加钢板固定加松质骨植骨术治疗。术中检查均证实骨折端存在旋转不稳定。结果随访时间7～35个月,平均14.5个月。23例患者骨折均获得愈合,愈合时间为8～20周,平均14周。无感染、内固定松动或断裂等手术相关并发症。结论保留原有髓内针附加钢板固定加植骨术可有效消除髓内针术后旋转不稳定,是治疗髓内针术后骨折不愈合简单、安全、有效的方法。
Objective To evaluate the effects of augmentative plate fixation and bone grafting with the nail in situ for the treatment of bone nonunion resulted from rotational instability after intramedullary nailing.Methods 23 cases of bone nonunions resulted from rotational instability after intramedullary nailing were treated with augmentative plate fixation and bone grafting leaving the nail in situ.There were 20 males and 3 female with an average age of 33.7 years（ranging 21～63 years）.The data consisted of 4 cases of tibial shaft fractures,16 femoral shaft fractures and 3 humeral shaft fractures.All fractures were initially managed with statically locked intramedullary nails,15 of which were inserted with closed nailing technique and 8 of which were inserted with open nailing technique.The mean time from primary nailing to plate augmentation and bone grafting was 17 months（ranging 9～38 years）.According to the radiographs,the nonunion was hypertrophic in 14 cases and atrophic in 9 cases.A rotational instability of the nonunion site was verified in all cases during the operation,while the instability disappeared after plate augmentation.Results The mean follow-up period was 14.5 months（ranging 7 to 35 months）.All 23 cases achieved bony union averaged 14 weeks after plate augmentation and bone grafting with a range of 8 to 20 weeks.There was no complication of infection or implant failure.Conclusion Augmentative plate fixation and bone grafting leaving the nail in situ appears to be effective,safe and simple for treatment of unstable bone nonunion after interlocking intramedullary nailing.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第18期2032-2034,共3页
Chinese General Practice
关键词
骨折固定术
髓内
骨折
不愈合
骨移植
旋转
Fracture fixation
intramedullang
Fractres
ununited
Bone transplantation
Rotation
