皮质骨剥离及附加钢板植骨治疗髓内钉固定后股骨干非肥大型骨不连的临床疗效  

Clinical efficacy of cortical bone stripping and additional plate bone grafting in the treatment of non-hypertrophied bone nonunion of the femoral shaft after intramedullary nailing

作　　者：马腾[1] 许毅博 任程[1] 路遥[1] 李明[1] 孙亮[1] 宋哲[1] 薛汉中[1] 王谦[1] 李忠[1] 张堃[1] MA Teng;XU Yi-bo;REN Cheng;LU Yao;LI Ming;SUN Liang;SONG Zhe;XUE Han-zhong;WANG Qian;LI Zhong;ZHANG Kun(Department of Orthopeadics,Honghui Hospital,Xi'an Jiaotong University Health Science Center,Xi'an,Shaanxi,710054,China)

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,陕西西安710054

出　　处：《中国骨与关节杂志》2021年第9期661-664,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨 Judet 皮质骨剥离法结合自体髂骨植骨结合附加波形钢板治疗股骨干髓内钉骨折术后髓内钉无法取出的无菌性非肥大型骨不连的临床疗效。方法回顾性分析 2013 年 7 月至 2019 年 7 月收治的 33 例股骨干髓内钉骨折术后髓内钉无法取出的无菌性骨不连患者资料,男 25 例,女 8 例;年龄为 22~56 岁,平均 43.2 岁。骨不连情况:首次骨折开放复位 33 例;已接受过单纯第二次手术植骨治疗 5 例;已接受过第二次附加钢板且植骨治疗 2 例。手术均采用保留原股骨髓内钉 Judet 皮质骨剥离法结合自体髂骨植骨附加波形钢板内固定。术后复查使用 Samantha X 线评分对骨愈合进行评估。结果 1 例患者术中判断为低毒感染予以退组,3 例术后失随访。其余 29 例术后获 12~24 个月随访,平均 17.4 个月。术后无感染、肺炎、脂肪栓塞、下肢深静脉血栓形成等并发症发生。29 例患者骨折均获骨性愈合,愈合时间 3~6 个月,平均 5.9 个月,未出现骨不连、内固定失效等并发症。结论对于股骨干髓内钉骨折术后髓内钉无法取出的无菌性非肥大型骨不连患者,Judet 皮质骨剥离法结合自体髂骨植骨治疗结合附加波形钢板固定是一种有效的治疗方式。Objective To discuss clinical efficacy of cortical bone stripping and additional plate bone grafting in the treatment of non-hypertrophied bone nonunion of the femoral shaft after intramedullary nailing.Methods A series of 33 patients with non-hypertrophied bone nonunion of the femoral shaft after intramedullary nailing was retrospective analyzed from July 2013 to July 2019,including 25 males and 8 females.The average age was 43.2 years(range:22-56 years).There were 33 cases with open reduction for the first fracture;5 cases had received a second operation with bone grafting;2 cases had received a second operation with additional steel plate and bone grafting.Judet cortical bone stripping and additional plate bone grafting were applied in all patients.Bone healing was evaluated by Samantha X-line scoring standard.Results One patient diagnosed as low-toxic infection during operation was excluded;3 cases lost follow-up after operation.All 29 patients were followed up for 12-24 months (mean:17.4 months) after operation.No complications such as infection,pneumonia,fat embolism,deep venous thrombosis of the lower extremity,nonunion and internal fixation failure was seen.Bone healing was achieved in all patients.Healing time averaged 5.9 months (range:3-6 months).Conclusions Judet cortical bone stripping and additional plate bone grafting are recommended in the treatment of non-hypertrophied bone nonunion of the femoral shaft after intramedullary nailing.

关 键 词：股骨 假体和植入物 骨不连 骨钉 

分 类 号：R683.4[医药卫生—骨科学]