经皮骨断端削切结合骨延长加压术微创治疗下肢骨折不愈合  

Percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones

作　　者：张伟[1] 张群[1] 唐佩福[1] 张立海[1] 张里程[1] 郝明[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华创伤骨科杂志》2016年第12期1028-1032,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评价应用经皮骨断端削切结合骨延长加压术微创治疗下肢骨折不愈合的疗效。方法对2011年9月至2014年12月采用经皮骨断端削切结合骨延长加压术微创治疗的32例下肢骨折不愈合患者资料进行回顾性研究，男23例，女9例；年龄15～62岁，平均33．4岁。治疗方式为先将原有的内、外固定物取出，再用可延长的单臂或环形外固定支架在骨折端两边固定。透视下用一5mm宽的薄骨刀经皮穿刺至骨断端，沿骨折线将骨断端间的瘢痕剥离切断；打通髓腔，并将硬化的骨断端凿出不规则的新创面；再用骨刀在距骨折两个断端2cm内的骨皮质表面进行凿切，将骨皮质表面呈“鱼鳞状”削切出一层薄骨片（直径约5mm、厚约1mm），再调整外固定支架将骨断端加压。术后8d开始利用外固定支架，通过牵张延长．短缩加压技术刺激骨生长至愈合。结果所有患者术后获8～42个月（平均12．5个月）随访。28例患者一期愈合；3例患者出现延迟愈合后，经局部注射骨髓血和（或）冲击波等辅助治疗，最终也获得愈合。愈合时间为4～7个月，平均4．6个月；带架时间为5～8个月，平均6．2个月。1例患者术后6个月胫骨外侧皮质骨局部不愈合，经植自体髂骨后愈合。所有患者术后关节功能与本次术前的功能情况基本相同。结论经皮骨断端削切结合骨延长加压术微创治疗下肢骨折不愈合是一种简单、微创、有效的方法，能够避免传统手术方法带来的创伤大、出血多等问题。Objective To evaluate the curative effects of percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones. Methods A retrospective analysis was performed of the 32 patients who had been treated using osteoperiosteal decortication combined with distraction osteogenesis from September 2011 to December 2014 for nonunion of lower-extremity fractures. They were 23 males and 9 females, with a mean age of 33.4 years （range, from 15 to 62 years）. After their former internal or external fixators were removed, the 2 fracture ends were fixated by a retractile mono-latera] or circular external fixator. Under radiographic monitoring, a percutaneous incision was made with a 5 mm sharp chisel, down to the bone. Scar and ossified tissue between the fracture ends were debrided and cut along the fracture line. After the marrow cavity was reamed, a new irregular wound was created at sclerotic fracture ends. Scale-shaped chips （1 mm thin and 5 mm in diameter） were elevated using a chisel on surface of the cortical bone within 2 cm from the fracture ends. The external fixators were adjusted to compress the fracture sites. On the 8tb day after operation, the eternal fixators were applied to distract and compress at nonunion sites to stimulate the osteogenesis. Results All the patients were followed up for an average of 12.5 months （range, from 8 to 42 months）. Primary union was successfully achieved in 28 patients while delayed union occurred in 3 patients who finally achieved union after adjuvant therapies like shock wave and or local injection of bone marrow blood. The average time for union was 4.6 months（range, from 4 to 7 months）. The mean time for external fixation was 6.2 months （range, from 5 to 8 months）. One patient encoun- tered nonunion of lateral tibial cortical bone 6 months after surgery but eventually achieved union by au- tologous ilium grafting. Joint functions in all postoperative patients were similar to those before opera-

关 键 词：骨延长术 骨折 不愈合 外科手术 微创性 经皮削切 

分 类 号：R687.3[医药卫生—骨科学]