带锁髓内钉治疗胫骨骨折术后骨不连的成因与治疗对策  

Causes and treatment measures for nonunion of tibia shaft fracture after treatment with interlocking intramedullary nail

作　　者：陈华[1] 郭晓山[1] 赵友明[1] 陈龙[1] 余可和[1] 李驰[1] 

机构地区：[1]温州医学院附属第二医院骨科,325027

出　　处：《中华创伤杂志》2007年第7期496-498,共3页Chinese Journal of Trauma

摘　　要：目的分析带锁髓内钉治疗胫骨骨折术后骨不连的原因和临床特点，探讨治疗对策。方法通过分析30例胫骨骨折术后骨不连临床表现、X线特点，采取更换髓内钉为钢板加植骨、单纯髓内钉动力化、髓内钉动力化加植骨和更换髓内钉加植骨4种不同的治疗方法。结果本组30例，愈合时间为8～12．5个月，平均10．5个月。功能评定为优21例，良7例，可1例，差1例，优良率为93％。结论对营养不良性骨不愈合，采用更换髓内钉为钢板加植骨，对肥厚性骨不愈合采用单纯髓内钉动力化、髓内钉动力化加植骨或更换髓内钉加植骨方法，可取得良好效果。Objective To study causes and clinical characteristics of postoperative tibia fracture nonunion after intramedully nail fixation and explore corresponding effective treatment measures. Methods Based on clinical and radiogical characteristics of 30 consecutive patients with postoperative tibia fracture nonunion following intramedullary nail fixation, we carried out four different revision methods including intramedullary nail removal and replaced with plate fixation and bone graft implantation, intramedullary nail dynamization, intramedullary nail dynamization with bone graft implantation, intramedullary nail exchange and bone graft implantation. Results The union time of all patients following revision surgery ranged from 8 to 12.5 months （ average 10.5 months）. According to functional evaluation criteria, the results were excellent in 21 cases, good in 7, satisfactory in 1 and poor in 1, with excellence rate of 93%. Conclusions As for hypertrophy fractures nonunion type, intramedullary nail is removed and replaced with plate fixation and bone graft implantation. As for dystrophy fractures nonunion type, the methods such as intramedullary nail dynamization, intramedullary nail dynamization plus bone graft implantation or intramedullary nail exchange plus bone graft implantation can attain good results.

关 键 词：胫骨骨折 骨折 不愈合 髓内钉 

分 类 号：R686[医药卫生—骨科学]