双钢板内固定联合自体髂骨植骨在股骨骨不连中的应用现状及研究进展  

Application and research progress of double plate internal fixation combined with autogenous iliac bone graft for femur nonunion

作　　者：叶浩波 孙亮[2] 薛汉中[2] 李忠[2] 田丁[2] 杨娜[2] 张堃[2] Ye Haobo;Sun Liang;Xue Hanzhong;Li Zhong;Tian Ding;Yang Na;Zhang Kun(Xi’an Medical University,Xi’an 710068,China;Department of Orthopaedics and Trauma,Xi’an Jiaotong University Medical College Red Cross Hospital,Xi’an 710054,China)

机构地区：[1]西安医学院,710068 [2]西安交通大学医学院附属红会医院创伤骨科,7100542

出　　处：《中华骨科杂志》2020年第16期1118-1125,共8页Chinese Journal of Orthopaedics

基　　金：陕西省科技厅重点项目(2017ZDXM-SF-009);西安市科技局学科平台能力建设(重点)项目(2019116413YX019SF052)。

摘　　要：股骨骨不连是股骨骨折髓内钉术后常见的并发症,发生率为1%~12.5%。目前,股骨骨不连的治疗方式主要分为手术治疗和非手术治疗,而手术治疗为首选方式。手术治疗股骨骨不连的金标准是更换髓内钉,但对于非峡部的股骨骨不连,即使更换大直径的髓内钉,仍然不能解决骨不连断端旋转和成角移位的问题;对于营养不良型骨不连、萎缩型骨不连以及有大块骨缺损的骨不连仅通过更换髓内钉并借助自体骨植骨不足以消除断端间隙、增加断端间接触面积,无法为骨不连断端提供一个良好的生物学环境。另外,更换髓内钉时并不显露骨不连断端,故无法取相应的组织进行细菌学培养,对判断骨不连断端是否合并感染有一定难度。双钢板技术是切开直视下找到骨不连部位,并在骨不连断端放置不同角度的两块钢板进行固定。查阅近10年国内外已发表的与双钢板技术治疗股骨骨不连相关的文献,经分析总结得出双钢板固定联合自体髂骨植骨为骨不连的愈合提供了一个三维立体固定模型,具有稳定性强的特点,在改善骨折端的生物学行为和机械稳定性方面发挥着积极的作用,术后有利于膝关节屈伸活动,同时愈合率高、并发症发生率低,可有效缓解疼痛。Nonunion of femur is a common complication after intramedullary nail operation of femoral fracture,with an incidence of 1%to 12.5%.At present,the treatment of femoral nonunion is mainly divided into surgical treatment and non-operative treatment,and surgical treatment is the first choice.The gold standard for surgical treatment of femoral nonunion is replacement of intramedullary nail,but for non-isthmus femoral nonunion,larger diameter intramedullary nail could not solve the problem of rotation and angular displacement of the broken end of nonunion.For malnourished nonunion,atrophic nonunion and bone nonunion with large bone defect,the replacement of intramedullary nail and autogenous bone graft are not enough to eliminate the gap between the broken ends and increase the contact area between the broken ends.It cannot provide a good biological environment for the broken ends.Because the replacement of intramedullary nail does not expose the broken ends of bone nonunion,and the corresponding tissue cannot be taken for bacteriological culture,so it is difficult to judge whether the broken end sare complicated with infection.The double plate technique is to find the site of bone nonunion under direct vision,and two plates are placed with different angles.This paper reviews the literature related to the treatment of femoral nonunion with double plate technique published at home and abroad in the past 10 years,and concludes that double plate fixation combined with autogenous iliac bone graft provides a three-dimensional fixation model for the healing of nonunion.It has the characteristics of strong stability and plays an active role in improving the biological behavior and mechanical stability of the fracture ends.The operation is beneficial to the flexion and extension of the knee joint,with the characteristics of high healing rate,low complication rate,effective pain relief and so on.

关 键 词：股骨骨不连 细菌学培养 生物学环境 骨折端 萎缩型 机械稳定性 股骨骨折 峡部 

分 类 号：R687.3[医药卫生—骨科学]