同种异体骨移植术后骨不连成因及治疗方法分析  

CAUSES AND TREATMENT OF LONG BONE FRACTURE NONUNION AFTER ALLOGENEIC BONE GRAFTING SURGERY

作　　者：王志强[1] 宋会平[1] 邓华民[2] 陈杰[2] 张立峰[2] 李冀[2] 

机构地区：[1]华北煤炭医学院附属医院骨科中心河北省创伤研究所,河北唐山063000 [2]唐山市第二医院

出　　处：《中国修复重建外科杂志》2009年第5期534-537,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结同种异体骨移植治疗长骨骨折术后骨不连形成原因及治疗方法。方法1995年12月-2000年12月,应用同种异体骨移植治疗长骨骨折,术后发生骨不连43例。其中男31例,女12例;年龄19～57岁,平均40岁。骨不连原因:软组织广泛挫灭6例,骨折区覆盖不良;骨髓炎清创术不彻底8例,其中未行持续灌洗6例,单纯局部皮瓣移位4例;伤口继发感染3例;严重原发性创伤或多次手术继发局部贴骨瘢痕12例;内固定不牢固7例;过早负重7例。根据Weber骨不连分型:肥大型4例,萎缩型39例。无假关节形成。骨折部位:股骨11例,胫骨21例,肱骨8例,前臂3例。根据骨不连类型,选择重新固定、再次植骨及组织瓣移植等多种方法联合治疗。结果术后切口Ⅰ期愈合37例;浅表感染5例,经换药2周后愈合;窦道形成1例,经换药、引流2个月后愈合。组织瓣移植均成活,其中4例皮瓣边缘部分坏死,换药后愈合。患者均获随访,随访时间38～91个月,平均54.6个月。骨不连均达骨性愈合,愈合时间5～11个月,平均7.6个月。术后发生下肢短缩畸形4例,畸形愈合2例,邻近关节活动部分受限7例,前臂旋转受限1例。结论同种异体骨移植术后骨不连主要呈萎缩型,稳定骨折、组织瓣移植、控制感染及充分植骨是治疗同种异体骨移植术后骨不连的有效方法。Objective To analyze the causes and managing methods of long bone fracture nonunion after allogeneic bone transplantation.Methods From December 1995 to December 2000, 43 cases of postoperative nonunion of long bone fracture were treated.These cases included 31 males and 12 females at the age of 19-57 years（40 years on average）.The locations were femur in 11 cases, tibia in 21 cases, humerus in 8 cases and forearm in 3 cases.Bone nonunion after allogeneic bone transplantation was caused by extensive soft tissue contusion and poor cover around bone fractue site in 6 cases, by incomplete debridement in 8 cases of osteomyelitis（including 6 without continual lavage and 4 only skin ap transfer）, by secondary infection of wounds in 3 cases, by severe primary injury or secondary scar covering bone in 12 cases, instable internal xation in 7 cases, and by earlier weight bearing in 7 cases.Accroding to Weber classi cation, there were 4 cases of hypertrophic type and 39 cases of atrophic type.Basing on the type of nonunion, the methods such as re xation, bone retransplantation and transferring tissue ap were chosen to manage the cases.Results Incision healed by rst intention in 37 cases, super cial infection occurred and cured after 2 weeks of dressing change in 5 cases, and sinus formed and cured after 2 months of dressing change and drainage in 1 case.All transferring tissue ap survived, and partial necrosis occurred at ap edge in 4 cases and cured after dressing change.All patients were followed up for 38-91 months with an average of 54.6 months.All the nonunion cases achieved bone union 5-11 months with an average of 7.6 months.But low extreme shorten monstrosity occured in 4 cases, malunion in 2 cases, functional limitation near joints in 7 cases, and rotational limitation of forearm in 1 case.Conclusion Fracture nonunion after allogeneic bone transplantation mainly shows atrophic type with overall or partial absorption of the allograft bone.The preconditions to guarantee fracture nonunion healing include stabil

关 键 词：同种异体骨移植 并发症 骨不连 骨缺损 骨折固定 

分 类 号：R687.34[医药卫生—骨科学] R683[医药卫生—外科学]