改进植骨方式结合锁定加压钢板治疗胫骨中下段骨不连  

Advanced bone graft combined with locking compression plate for the treatment of middle and distal tibia nonunion

作　　者：赵雪[1] 王攀峰[1] 章云童[1] 张春才[1] 许硕贵[1] 张欣[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中国骨伤》2014年第12期1008-1011,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨改进植骨方式结合锁定加压钢板治疗胫骨中下段骨不连的方法.方法：自2011年1月至2012年12月,采用改进植骨方式结合锁定加压钢板治疗12例胫骨中下段骨不连患者,其中男8例,女4例;年龄20～69岁,平均47岁.初次外伤至此次骨不连手术时间为9个月～5年,平均1年7个月.伤后行外固定支架治疗4例,钢板内固定治疗6例,髓内钉治疗2例,其中2例来院时已出现钢板、螺钉断裂.11例为非感染性骨不连,1例为感染性骨不连.术前X线及CT检查提示全部病例有不同程度的死骨、硬化骨形成.术中记录手术时间、出血量,术后观察伤口愈合情况,并根据术后X线片复查情况评价骨愈合时间.术后10个月参照Johner-Wruhs标准对踝关节功能进行评分.结果：手术时间90～185 min,平均（125.00±20.15） min;术中出血量225～750ml,平均（415.00±120.00） ml.12例均获随访,时间10个月～2.5年,平均1.5年.术后复查X线片提示,全部病例4个月内骨断端形成骨桥样骨连接,3例6个月达到类骨板样骨愈合,其余9例术后8～12个月达到类骨板样骨愈合.术后未出现伤口感染,神经、血管损伤,钢板、螺钉断裂等手术并发症.术后10个月根据Johner-Wruhs标准进行踝关节功能评价,优10例,良1例,可1例.结论：采用改进植骨方式结合锁定加压钢板,在骨不连断端充分加压的基础上建立骨断端多点支撑,实现有效固定是治疗胫骨中下段骨不连的有效方法.Objective：To explore methods of treating middle and distal tibia nonunion with the treatment of advanced bone graft combined with locking compression plate.Methods：From January 2011 to December 2012,12 patients with middle and distal tibia nonunion were treated with advanced bone graft combined with locking compression plate.Among patients,there were 8 males and 4 females aged from 20 to 69 with an average of 47 years old.The time from first injuries to bone nonunion was from 9 months to 5 years,avergaed 19 months.Four cases were treated with external fixation,6 cases were treated with plate fixation,2 cases of 12 patients occurred broken of plate and nail.Eleven patients were non-infective bone nonunion and 1 patient was infective bone nonunion.Preoperative X-ray and CT showed all patients had sequestration and formation of ossified bone with different degrees.Operative time,blood loss,wound healing were observed,fracture healing time was evaluated by postoperative X-ray.Johner-Wruhs scoring standards was used to evaluate ankle joint function after operation at 10 months.Results：Operative time ranged from 90 to 185 min with an average of （125.00±20.15） min; blood loss ranged from 225 to 750 ml with an average of （415.00±120.00） ml.All patients were followed up from 10 months to 2.5 years with an average of 1.5 years.Postoperative X-ray showed bone union was formed around fracture after operation at 4 months in all patients,3 cases obtained bone healing within 6 months after operation,9 cases obtained from 8 to 12 months.No infection,injury of nerve and vessles,and broken of plate and nail were ocurred.According to Johner-Wruhs scoring at 10 months after operation,10 cases obtained excellent results,1 good and 1 moderate.Conclusion：Advanced bone graft combined with locking compression plate,which can build fracture multi-point supporting based on full compression of bone nonunion to get effective fixation,is an effective method in treating middle and distal tibia nonunion.

关 键 词：胫骨 骨折 外固定器 骨折愈合 

分 类 号：R683[医药卫生—骨科学]