关节镜辅助下植骨治疗萎缩型长骨骨折不愈合  

Arthroscopic bone autografting for treatment of atrophy nonunion of long bone fractures

作　　者：李忠 申丽英 杨洪彬 王远辉 王治 阳运康 鲁晓波 杨柳[2] 

机构地区：[1]沪州医学院附属医院骨关节外科,646000 [2]第三军医大学附属西南医院关节外科中心

出　　处：《中华创伤杂志》2009年第11期992-996,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（30672200）;四川省卫生厅资助项目（080180）

摘　　要：目的介绍关节镜辅助下清创、自体髂骨移植治疗萎缩型长骨骨折不愈合，特别是伴有严重皮肤软组织损伤的萎缩型不愈合的初步经验。方法选择13例萎缩型长骨骨折不愈合，其中男8例，女5例。伴严重皮肤软组织损伤7例。x线监视下建立两个关节镜入口，关节镜直视下骨折端清创、自体松质骨移植治疗。结果骨折端手术平均出血量为15ml，平均手术时间为65min。除取髂骨区出现并发症外，植骨区都无严重的术中和术后并发症，所有骨折均获得无痛和稳定的骨性愈合，关节活动范围无进一步丢失。骨折愈合时间3～7个月，平均为5．2个月。结论关节镜辅助下植骨治疗萎缩型长骨不愈合，创伤小，愈合率高，特别适用于伴有严重皮肤软组织损伤的患者。Objective To introduce preliminary experiences using arthroseopic debridement and bone autografling to treat atrophy nonunion of long bone fractures, especially those with severely damaged soft tissues. Methods There were 13 patients （8 males and 5 females） with atrophy nonunion of long bone fractures, of whom seven patients were associated with severely damaged soft tissues. Under guidance of radiography, two portals for insertion of arthroscope were created towards the nonunion site. Then, debridement of the fracture and bone autografting were performed under arthroseope. Results The operation lasted for mean 65 minutes, with mean blood loss of 15 ml. No severe complications at the nonunion site dining and after operation were found except for complications related to the iliac crest donor site. All fractures were healed, without pain, instability or loss of functional range of movements. The duration of fracture healing was 3-7 months （ mean 5.2 months）. Conclusions Arthroscopic bone autographing in treatment of atrophy nonunion of long bone fractures is proved to be an minimally invasive surgery, with high fracture healing rate, and is especially suitable for those with severely damaged soft tissues.

关 键 词：骨折 不愈合 关节镜 胫骨骨折 股骨骨折 肱骨骨折 

分 类 号：R687.3[医药卫生—骨科学]