双钢板垂直固定结合自体髂骨结构植骨治疗萎缩性骨不连  

Double plate vertical fixation combine with autologous bone graft in the treatment of atrophic nonunion

作　　者：孙亮[1] 薛汉中[1] 王谦[1] 卢代刚[1] 李忠[1] Sun Liang;Xue Hanzhong;Wang Qian(Lower extremity Ward,Skeletal Trauma Hospital,the Affiliated Honghui Hospital of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院骨创伤医院下肢病区,710054

出　　处：《美中国际创伤杂志》2022年第1期44-48,52,共6页U.S.Chinese International Journal of Traumatology

摘　　要：目的:探讨双钢板垂直固定结合自体髂骨结构植骨治疗萎缩性骨不连的疗效。方法:回顾性分析2019年1月至2020年5月收治的43例萎缩性骨不连患者资料。男27例,女16例;年龄23〜68岁,平均42岁;其中胫骨干骨不连17例,股骨干骨不连21例,肱骨干骨不连4例,桡骨干骨不连1例;骨不连病程6〜156个月,平均24.2个月;骨不连手术次数:2次11例(采用钢板+钢板7例、外固定架+钢板2例、髓内钉+钢板1例、钢板+植骨1例),1次32例(均采用钢板)。所有患者术中均采用双钢板垂直固定结合自体髂骨结构植骨治疗。结果:所有患者术后获8~28个月(平均14.5个月)随访。43例患者均获骨愈合,愈合时间为5~14个月,平均8.2个月。治愈率100%,无1例患者术后发生感染、内固定断裂等并发症,术后骨骼评分及功能评分优良率100%。结论:双钢板垂直固定结合自体髂骨结构植骨能够提供稳定的力学环境,并充分发挥自体骨成骨效应,是一种值得信赖的治疗方法。然而,其愈合时间较其他方法较长,且伴随少量患者出现跛行、关节僵硬、肌肉萎缩等长期并发症。因此,其最佳适应症为伴随骨缺损或明显畸形、病程较长的钢板术后萎缩性骨不连。Objective:To investigate the effect of vertical fixation with double plate combined with autologous iliac bone graft in the treatment of atrophic nonunion.Methods:From January 2019 to May 2020,43 patients(including 27 male and 16 female,aging from 23 to 68 years,with an average of 42 years)with a-trophic nonunion,were treated with double plate vertical fixation combined with autologous bone graft.A-mong them,tibial,femoral,humeral and radial shaft nonunion in 17,21,4 cases and 1 case respectively.The duration of nonunion was 6-156 months,with an average of 24.2 months,the number of operation:2 times in 11 cases(plate+plate in 7 cases,with external fixator+plate in 2 cases,intramedullary nail+plate in 1 case,plate+bone grafting in 1 case)and 1 time in 32 cases(plate in all cases).Results:All patients were followed up for 8-28 months(mean 14.5 months)and achieved bony union,without complications such as wound infection or fixation failure.The healing time was 5-14 months,with an average of 8.2 months,nonunion cure rate is 100%.Conclusion:Double plate fixation and bone grafting is a trusted treatment method for atrophic nonunion due to its strong stability and fully bone graft availability.However,its healing time is longer than other methods,and a small number of patients experience long-term complications such as lameness,joint stiffness,muscle atrophy,etc.Therefore,the best indication for this method is atrophic nonunion after plate surgery with bone defect or obvious deformity and a long course of disease.

关 键 词：双钢板 垂直固定 植骨 萎缩性骨不连 

分 类 号：R68[医药卫生—骨科学]