更换髓内钉和联合自体骨植骨、保留髓内钉附加侧板治疗股骨干骨折髓内钉术后骨不连  

Exchange reamed intramedullary nailing versus augmentation compression plating plus autogenous bone grafting for femoral shaft nonunion after intramedullary nailing

作　　者：茹江英[1] 丛宇[2] 康文博[2] 鲁扬虎[3] 陈晓[3] 曹烈虎[3] 苏佳灿[3] 纪方[3] 牛云飞[3] 

机构地区：[1]扬州市第一人民医院骨科,225009 [2]南京大学医学院附属金陵医院骨科 [3]第二军医大学长海医院骨科

出　　处：《中华创伤杂志》2015年第7期585-591,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金面上资助项目（31271031）;国家自然科学基金国际重大合作资助项目（8141101156）;上海市科委基础基金资助项目（11JC14163020）

摘　　要：目的 回顾性分析更换髓内钉术（ERN）与联合自体骨植骨/保留髓内钉附加侧板术（ACP）治疗非感染性股骨干骨折髓内钉术后骨不连的临床疗效.方法 对分别采用ERN（A组）与联合自体骨植骨/ACP（B组）治疗股骨干骨折髓内钉术后骨不连患者进行一项多中心性、回顾性队列研究.A组（86例,87侧）非峡部段骨不连42侧（48％）,峡部段骨不连45侧（52％）;B组（92例,93侧）非峡部段骨不连46侧（49％）,峡部段骨不连47侧（51％）.比较两组手术时间、术中出血量、骨愈合时间、骨愈合率、术后引流量和术后并发症发生率等.结果 所有患者平均随访4.1年（1～7.1年）,A组和B组的骨愈合率分别为86％和100％（OR=3.28,95％ CI 0.8～14.0）.A组12侧术后发生再骨不连,其中非峡部段骨不连10侧（83％）,伴有皮质骨缺损＞3 cm的峡部段骨不连2侧（17％）.与B组比较,A组的骨愈合时间、术中出血量、术后并发症发生率显著增高,骨愈合率显著降低（P＜0.05）,两组手术时间和术后引流量比较差异无统计学意义（P＞0.05）.但对于非峡部段骨不连,A组的手术时间[（127.3±21.7）min]较B组[（89.9±14.1）min]显著增加（P＜0.05）.结论 与ERN比较,采用联合自体骨植骨/ACP治疗股骨干髓内钉术后骨不连,骨愈合时间更短,且可获得更高的骨愈合率.尤其对于伴较大骨缺损的峡部段骨不连或非峡部段的骨不连患者,采用联合自体骨植骨/ACP较ERN具有更大的优势.Objective To retrospectively compare the outcomes between exchange reamed intramedullary nailing （ERN） and augmentation compression plating （ACP） combined with autogenous bone grafting in treatment of femoral shaft nonunion after intramedullary nailing.Methods A multicentre retrospective study was performed for 178 patients （180 sides） with femoral shaft nonunion after intramedullary nailing.Eighty-six （87 sides） out of the 178 patients underwent ERN （Group A） consisting of nonisthmal nonunions in 42 sides （48%） and isthmal nonunions in 45 sides （52%）.The remaining 92 patients （93 sides） underwent ACP combined with autogenous bone grafting （Group B）consisting of nonisthmal nonunions in 46 sides （49%） and isthmal nonunions in 47 sides （51%）.Comparative study was made on operation time,intraoperative blood loss,time to union,union rate,postoperative draining volume and complication rate.Results Mean follow-up was 4.1 years （range,1-7.1 years）.Union rate was 86% for Group A and 100% for Group B （OR =3.28,95% CI 0.8-14.0）.In Group A renonunion was seen in 12 sides including nonisthmal nonunions in 10 sides （83%） and isthmal nonunion with cortical bone defect 〉 3 cm in 2 sides （17%）.Group A reported higher values in time to union,intraoperative blood loss as well as complication rate and lower healing rate over Group B（P 〈 0.05）,but no significant differences were found in the operation time and drainage volume between the two groups （P 〉 0.05）.However,for nonisthmal nonunions,operation time was （127.3 ± 21.7） min in Group A versus （89.9 ± 14.1） min in Group B （P 〈 0.05）.Conclusions In contrast,ACP combined with autogenous bone grafting results in shorter time to union and higher bone union rate during the treatment of femoral shaft nonunion after failed intramedullary nailing.Especially for nonisthmal or isthmal femoral shaft nonunions with larger bone defect,ACP combined with autogenous bone grafting brings relatively more adva

关 键 词：股骨骨折 骨折 不愈合 髓内钉 

分 类 号：R687.3[医药卫生—骨科学]