摘要
目的:探讨扩髓保留髓内钉联合附加侧板植骨、更换髓内钉治疗下肢骨干骨折髓内钉术后非感染性骨不连的临床疗效。方法:选择下肢骨干骨折髓内钉固定术后非感染性骨不连患者86例,将其随机分成观察组(n=43)与对照组(n=43),观察组采用扩髓保留髓内钉联合附加侧板植骨治疗,对照组则运用更换髓内钉治疗,比较两组临床疗效。结果:观察组患者的手术时间、术中出血量、术中输悬浮红细胞量均低于对照组(P<0.01):两组术后引流量与住院时间比较差异无统计学意义(P>0.05)。两组患者的切口均属于Ⅰ期愈合,没有血管与神经损伤等发生。治疗后,两组患者无一例出现感染、畸形愈合与患肢功能障碍等并发症。两组患者均得到骨性愈合,其中观察组患者的临床骨愈合时间与影像学骨愈合时间均明显优于对照组(P<0.01)。末次随访时,按照Tohner-WFrnch标准给予评定,发现观察组的优良率为100%,对照组的优良率为86%,差异有统计学意义(P<0.05)。结论:扩髓保留髓内钉联合附加侧板植骨治疗下肢骨干骨折髓内钉术后非感染性骨不连的效果优于更换髓内钉,此法操作简单、手术时间比较短、临床效果显著,是治疗非感染性骨不连的一种良好方法。
Objective：To evaluate the clinical efficacy of augmentation compression plating （ACP ） combined with autogenous bone grafting and exchange reamed intramedullary nailing （ERN）for treatment of non-infectious nonunion after intramedullary nailing of lower extremity shaft fractures. Methods：Included in this study were 86 patients with non-infectious nonunion after intramedullary nailing of lower extremity shaft fractures,who were randomly divided into the study group （n=43）and control group （n=43）. The study group received ACP plus ERN,while the control group received ERN alone. The clinical efficacy was compared between the two groups.Results：The patients in the study group experienced less operation time,blood loss,and intraoperative transfusion of red blood cell suspension compared with the control group （P〈0.01）. There were no significant differences in postoperative drainage and hospital stay between the two groups （P〉0. 05 ）. All patients had wounds healed primarily. There was no injury to blood vessels and nerves. After treatment,none of the patients developed infection,malunion,limb dysfunction or other complications. All patients achieved bone healing,with shorter time to clinical and radiological bone healing in study group compared with the control group （P〈0.01）. During the last follow-up,the study group showed 100%vs 86%excellent outcomes in the control group according to according to Johner-Wruh criteria,with statistically significant difference between the groups （P〈0. 05 ）. Conclusion：ACP plus ERN can be advantageous over ERN alone in treatment of non-infectious nonunion afternbsp;intramedullary nailing of lower extremity shaft fractures. In addition,ACP plus ERN is operatively simple and less time-consuming,but results in significant clinical efficacy,therefore,it is ideal for treatment of non-infected nonunion.
出处
《广州医科大学学报》
2016年第4期56-60,共5页
Academic Journal of Guangzhou Medical University
关键词
下肢骨干骨折
非感染性骨不连
扩髓保留髓内钉
更换髓内钉
lowerextremityshaftfractures
non-infectednonunion
augmentationcompressionplating
exchange reamed intramedullary nailing
