阻挡钉治疗胫骨干骨折髓内钉术后肥大性骨不连  

Blocking screws for hypertrophic nonunion secondary to intramedullary nailing of tibial shaft fracture

作　　者：陆定贵[1] 姚顺晗 林佳杰[1] 张卫扬 何凤英 LU Ding-gui;YAO Shun-han;LIN Jia-jie;ZHANG Wei-yang;HE Feng-ying(Departmen of Orhopeies,Affiliated Hospial Youyiang Natinal Medical College,Baise 533000,China)

机构地区：[1]右江民族医学院附属医院骨外科,广西百色533000

出　　处：《中国矫形外科杂志》2022年第14期1314-1317,共4页Orthopedic Journal of China

基　　金：广西高校中青年教师基础能力提升项目(编号:2018KY0449);广西壮族自治区卫生和计划生育委员会自筹经费科研项目(编号:Z20170243);百色市科学研究与技术开发计划项目(编号:20170512);百色市科学研究与技术开发计划项目(编号:百科计20141103);广西重点研发项目(编号:桂科A18050008)。

摘　　要：[目的]探讨阻挡钉治疗胫骨干骨折交锁髓内钉术后肥大性骨不连的临床疗效。[方法]回顾性分析2014年1月—2019年12月采用阻挡钉治疗的胫骨干骨折交锁髓内钉术后肥大性骨不连34例患者的临床资料。其中,男15例,女19例;平均年龄(39.55±10.85)岁;均为闭合性骨折,AO分型:A型12例,B型17例,C型5例。总结阻挡钉治疗临床与影像资料。[结果]所有患者均顺利完成手术,术中无血管、神经损伤等严重并发症,手术时间(41.18±11.53)min、切口长度(2.09±0.79)cm、术中出血量(4.58±2.36)ml、术中透视(4.32±1.25)次。患者术后均获随访(20.21±6.26)个月,术后随时间推移,VAS评分逐渐减小,膝关节HSS评分、踝关节AOFAS评分显著增加(P<0.05)。其中有31例术后骨折愈合,愈合时间(5.71±1.40)个月,3例骨折未愈合,予更换直径更大髓内钉及植骨后痊愈。[结论]应用阻挡钉治疗胫骨干骨折交锁髓内钉术后肥大性骨不连是一种微创、安全、高效的手术方式。[Objective]To investigate the clinical outcomes of blocking screws for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture.[Methods]A retrospective study was done on 34 patients who underwent additional blocking screws for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture from January 2014 to December2019.Of them,15 males and 19 females aged(39.55±10.85)years on average,and suffered closed AO type A in 12 cases,type B in 17 cases and type C in 5 cases.The clinical and imaging data of additional blocking screw therapy were summarized.[Results]All the patients were successfully operated on without any serious complications,such as vascular and nerve injury,whereas with operative time of(41.18±11.53)min,the incision length of(2.09±0.79)cm,intraoperative blood loss of(4.58±2.36)ml,and the intraoperative fluoroscopy of(4.32±1.25)times.As time went during the follow-up period lasted for(20.21±6.26)months,the VAS score significantly decreased,whereas the knee HSS score and ankle AOFAS score increased significantly(P<0.05).All patients got nonunion healed in(5.71±1.40)months,except3 patients were prone to remain fracture nonunion,which finally healed after revision surgery of replacement of a larger diameter intramedullary nail and bone grafting.[Conclusion]Additional blocking screw is a minimally invasive,safe and efficient treatment for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture.

关 键 词：胫骨干骨折 交锁髓内钉 肥大性骨不连 阻挡钉 

分 类 号：R683.42[医药卫生—骨科学]