通道成骨技术治疗股骨干无菌性非肥大型骨不连的疗效研究  

Effectiveness of tunnel osteogenesis technique in treatment of aseptic non-hypertrophic nonunion of femoral shaft

作　　者：叶浩波 孙亮[2] 薛汉中[2] 李忠[2] 张堃[2] YE Haobo;SUN Liang;XUE Hanzhong;LI Zhong;ZHANG Kun(Xi’an Medical University,Xi’an Shaanxi,710068,P.R.China;Department of Orthopaedics and Trauma,Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University,Xi’an Shaanxi,710054,P.R.China)

机构地区：[1]西安医学院,西安710068 [2]西安交通大学医学院附属红会医院创伤骨科,西安710054

出　　处：《中国修复重建外科杂志》2022年第8期976-982,共7页Chinese Journal of Reparative and Reconstructive Surgery

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：目的 探讨通道成骨技术辅以锁定钢板治疗股骨干无菌性非肥大型骨不连的疗效。方法 回顾分析2017年1月—2020年12月采用通道成骨技术辅以锁定钢板治疗的23例股骨干无菌性非肥大型骨不连患者。其中男17例,女6例;年龄22~72岁,平均41.4岁。闭合性骨折22例,开放性骨折1例。入院时内固定物类型包括髓内钉14例,钢板9例。既往接受骨不连手术0~1次;骨不连时间6~60个月,平均20.1个月。其中股骨干无菌性萎缩型骨不连17例,营养不良型骨不连6例。采用90°双钢板固定22例,采用单外侧锁定钢板固定1例。记录手术时间、理论失血量、住院时间、骨不连愈合情况和术后并发症;末次随访时采用Harris髋关节功能评分、Lysholm膝关节功能评分、下肢功能评价量表(LEFS)、简明健康调查量表(SF-36量表)评价髋、膝关节功能;术后1 d及末次随访时采用疼痛视觉模拟评分(VAS)评价疼痛改善情况。结果 手术时间平均190.4 min,理论失血量平均1 458.4 mL,住院时间平均8.2 d。23例患者均获随访,随访时间9~26个月,平均18.2个月。其中22例患者骨不连均愈合,愈合时间3~12个月,平均5.6个月;发生患肢疼痛8例、跛行8例、膝关节活动受限6例、髋关节活动受限2例。1例患者末次随访时影像学检查示骨不连未愈合,并伴随患肢疼痛、跛行、膝关节活动受限。术后1 d 23例患者VAS评分为(6.5±1.8)分,疼痛程度为良7例、中12例、差4例;末次随访时VAS评分为(0.9±1.3)分,疼痛程度达优21例、良2例,均较术后1 d显著改善(t=12.234,P<0.001;Z=–5.802,P<0.001)。末次随访时,22例骨不连愈合患者Harris髋关节功能评分平均94.8分,良好率100%;Lysholm膝关节功能评分平均94.0分,优良率90.9%;LEFS评分平均74.6分;SF-36量表中生理机能评分平均85.0分,精神健康评分平均83.6分。结论 通道成骨技术辅以锁定钢板治疗股骨干无菌性非肥大型骨不连愈合率高、�Objective To investigate the effectiveness of tunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft. Methods The clinical data of 23 cases of aseptic non-hypertrophic nonunion of femoral shaft treated with tunnel osteogenesis technique combined with locking plate between January 2017 and December 2020 were retrospectively analysed. There were 17 males and 6 females with an average age of 41.4 years(range, 22-72 years). There were 22 cases of closed fracture and 1 case of open fracture. The types of internal fixation at admission included intramedullary nail in 14 cases and steel plate in 9 cases. The number of nonunion operations received in the past was 0 to 1;the duration of nonunion was 6-60 months, with an average of 20.1months. Among them, there were 17 cases of aseptic atrophic nonunion of the femoral shaft and 6 cases of dystrophic nonunion. Twenty-two cases were fixed with 90° double plates and 1 case with lateral single plate. The operation time,theoretical blood loss, hospitalization stay, nonunion healing, and postoperative complications were recorded. Harris hip function score, Lysholm knee function score, lower extremity function scale(LEFS), and short-form 36 health survey scale(SF-36) were used at last follow-up to evaluate hip and knee functions. Visual analogue scale(VAS) score was used to evaluate the relief of pain at 1 day after operation and at last follow-up. Results The average operation time was 190.4minutes, the average theoretical blood loss was 1 458.4 mL, and the average hospitalization stay was 8.2 days. All the 23patients were followed up 9-26 months, with an average of 18.2 months. The healing time of nonunion in 22 patients was3-12 months, with an average of 5.6 months. There were 8 cases of limb pain, 8 cases of claudication, 6 cases of limitation of knee joint movement, and 2 cases of limitation of hip joint movement. At last follow-up, the imaging of1 patient showed that the nonunion did not heal, accomp

关 键 词：股骨干 锁定钢板 骨不连 通道成骨技术 

分 类 号：R687.3[医药卫生—骨科学]