四肢骨不连的原因和手术治疗  

The Causes and Surgical Treatment of Nonunion of Four Limbs

作　　者：殷浩[1] 孙俊英[1] 赖震[1] 李喜功[1] 宋兵华[1] 石岩[1] 

机构地区：[1]苏州大学附属第一医院骨科,310009

出　　处：《美中国际创伤杂志》2007年第3期18-21,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：探讨四肢骨不连的原因和手术疗效。方法：2003年1月～2006年6月共收治79例四肢骨折后骨不连患者。骨不连部位：肱骨中下段21，股骨远端10例，胫骨上段12例，胫骨远端19例，尺桡骨11例，锁骨远端3例，其它3例。本组患者全部采用内固定加植骨手术治疗。内固定：交锁髓内钉固定21，钢板螺钉固定58例；植骨方法：单纯生物活性玻璃陶瓷（商品名：固骼生）27例，自体骨混合生物活性玻璃陶瓷52例。结果：本组患者发生骨不连的主要原因严重创伤、手术影响、骨折部位和患者因素。全部患者获平均23．2个月（10～48个月）随访，均获骨性愈合，骨折愈合时间平均为6．1个月（3～11个月）。结论：骨不连的发生原因是多方面的，其中伤情严重和医源性是骨不连的主要原因；采用手术去除硬化骨、打通髓腔，坚强固定加自体或人工骨植骨可获得良好疗效。Objective：To retrospectively analyze the causes and surgical treatment of nonunion of four limbs. Methods： 79 cases of nonunion of four limbs were retrospectively studied from Jan. 2003 to June 2006. Nonunion were located at the humerus in 21 cases, distal femur in 10 cases, proximal tibia in 12 cases, distal tibia in 19 cases, radius or ulna in 11 cases, distal clavicle in 3 cases and other sites in 3 cases. All the cases were treated with open reduction and internal fixation combined with autogenous bone graft or a new artificial glass-Novebone. 21 cases were fixed with interlocked nails,58 with plate and screw. 27 cases received single graft of Novebone, 52 cases had autogenous bone graft combined with Novebone. Results：The main causes for nonunion were severe trauma, by-effect of operation, location of fracture and factors of the patients. All patients were followed up for mean 23.2 months （ranging from 10 to 48 months）. Bony union was achieved in all the patients after mean 6.1 months （ranging, 3-11 months）. Conclusion：Nonunion usually result from multiple causes, severe injury and byeffect of operation are the main causes. A good method for nonunion can be expected by excision of stiff bone, re-communication of medullary cavity, internal fixation combined with autogenous bone or artificial glass grafting.

关 键 词：长骨骨折 骨不连 原因 手术 治疗 

分 类 号：R683.4[医药卫生—骨科学]