优化穿针组合式外固定架治疗股骨远端骨不连的临床疗效  

Clinical outcomes of combined external fixator with optimized needle-pinning for distal femoral nonunion

作　　者：帕尔哈提.瓦哈甫 赵博[1] 艾科热木.吾普尔 王成伟[1] 李璐兵[1] 王雪[1] 梁玲玲[1] Paerhati Wahafu;ZHAO Bo;Aikeremu Wupuer;WANG Chengwei;LI Lubing;WANG Xue;LIANG Lingling(Department of Orthopaedic Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, China)

机构地区：[1]新疆医科大学第六附属医院骨病矫形外科,乌鲁木齐830002

出　　处：《中华骨与关节外科杂志》2019年第3期186-190,共5页Chinese Journal of Bone and Joint Surgery

基　　金：新疆维吾尔自治区区域协调创新专项科技支疆项目(2017E0278)

摘　　要：背景:骨不连是股骨远端骨折术后严重并发症,其发生率高,如何在内固定失效时尽可能小的创伤处理骨不连是创伤外科医师面临的一项难题。目的:评价优化穿针布局的组合式外固定技术治疗股骨远端骨折术后骨不连的临床疗效。方法:回顾性分析2010年5月至2016年12月间收治的采用优化穿针的组合式外固定架固定治疗的股骨远端骨折术后骨不连患者21例。13例行自体髂骨移植,8例行断端骨皮质剥脱术。采用X线检查评估骨折愈合,记录并对比术前与随访终末期膝关节活动度(ROM),终末随访时采用美国特种外科医院(HSS)评分评估膝关节功能。结果:所有患者术后随访10～26个月,平均随访(16.5±2.8)个月。21例患者均获得牢固骨性愈合,平均带架时间(9.3±1.6)个月,未见畸形愈合、感染,1例拆除外固定架后1个月发生再骨折。终末随访时膝关节ROM较术前有不同程度的改变,膝关节功能优良率为66.7%(14/21)。结论:采用优化穿针组合式外固定架治疗股骨远端骨不连的愈合率高,是一种安全、创伤小且简单易行的方法。但应注意膝关节最大屈曲度减少等并发症。Background: Nonunion is a serious postoperative complication of distal femoral fractures and has a high incidence. How to minimize the invasive treatment of nonunion after internal fixation failure is a difficult problem for trauma surgeons. Objective: To evaluate the clinical effect of combined external fixation for the nonunion of distal femoral fractures by optimizing the placement of needle-pinning. Methods: Retrospective analysis was made in 21 patients with combined external fixation for distal femoral nonunion from May 2010 to December 2016. Autogenous iliac bone grafting was performed 13 patients, and cortices were stripped on the broken end of fractured bone. X-ray examination was used to evaluate fracture healing. Range of motion (ROM) of the knee were recorded before surgery and at the last follow-up. The Hospital for Special Surgery (HSS) score was used to rank the function of knee joint at the last follow-up. Results: The mean duration of follow-up was (16.5±2.8) months (range, 10-26 months) in all the patients. Solid bone healing was achieved in all the patients.The mean retention time of frame was (9.3±1.6) months. No malunion or infection was found. Refracture occurred in one patient one month later after removing the external fixator. The excellent and good rate of knee joint function was 66.7%(14/21) at the last follow-up. Conclusions: It is a safe, minimally invasive and simple method to treat the nonunion of the distal femur by the combined external fixator with optimized needle-pinning. But pay attention to complications such as reduced maximum knee flexion.

关 键 词：股骨远端骨折 骨不连 外固定架 

分 类 号：R687.3[医药卫生—骨科学]