基于骨折端骨痂分级的下肢骨干骨折术后钢板断裂并原位骨折的治疗策略  

Treatment strategy for postoperative plate fracture and in situ fracture of lower extremity backbone fractures based on staging of fracture end bone scab

作　　者：涂俊波 江海翔 李粹和 黄晓武 李兴旺[1] Tu Junbo;Jiang Haixiang;Li Cuihe;Huang Xiaowu;Li Xingwang(Department of Orthopedics,Xinfeng County People's Hospital,Ganzhou Jiangxi,341600,China)

机构地区：[1]江西省信丰县人民医院骨二科(关节与创伤骨科),江西赣州341600

出　　处：《生物骨科材料与临床研究》2023年第3期59-63,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨下肢骨干骨折术后钢板断裂并原位骨折的治疗策略。方法回顾性分析2015年3月至2021年3月就诊于江西省信丰县人民医院下肢骨干骨折术后钢板断裂的26例患者临床资料、翻修手术信息及临床疗效。依据原始骨折部位的位置以及骨痂生长选择髓内钉或者解剖型锁定加压接骨板固定。在植骨与否的选择上原始骨折部位骨痂为Fernadez-esteve骨痂Ⅰ级、Ⅱ级一期行自体髂骨植骨手术,Fernadez-esteve骨痂Ⅲ级、Ⅳ级、Ⅴ级不给予植骨治疗。术后评价患者的骨折愈合时间、患肢临床疗效及髂骨供区并发症情况。结果所有患者随访至骨折愈合,所有患者获得临床愈合,愈合率100%,平均愈合时间5.92个月。所有患者随访期间均未出现内固定物再次断裂、松动等内固定物失效情况。按照Tohner-Wrnch标准,优16例,良10例,差0例,优良率100%。自体髂骨供区并发症达25.00%。结论下肢骨干内固定失败行翻修手术可根据患者原始骨折部位及骨痂生长情况综合考虑选择手术方式。Fernadez-esteve骨痂Ⅰ级、Ⅱ级原始骨折位于股骨干中段、上段患者建议采用顺行髓内钉行翻修手术,原始骨折位于股骨下段的患者采用逆行髓内钉或者股骨远端解剖型锁定加压接骨板固定,原始骨折部位于胫骨干建议选择胫骨髓内钉固定,同时骨折端一期行自体髂骨移植术;Fernadez-esteve骨痂Ⅲ级、Ⅳ级、Ⅴ级的股骨干、胫骨干患者建议选择锁定钢板固定,可考虑不给予自体骨移植治疗。Objective To investigate the treatment strategy for postoperative plate fracture with in situ fracture of the lower extremity backbone.Methods To retrospectively analyze the clinical data,review the surgical information and clinical outcomes of 26 patients who visited Xinfeng County People's Hospital from March 2015 to March 2021 with postoperative plate fractures of the lower extremity.Depending on the location of the original fracture site and the growth of the bone scab,either an intramedullary pin or an anatomic locking compression plate was selected for fixation.For the selection of bone grafting or not,the original fracture site with Fernadez-esteve bone scabs of gradeⅠandⅡwere treated with autologous iliac bone grafting,while Fernadez-esteve bone scabs of gradeⅢ,ⅣandⅤwere not treated with bone grafting.Postoperatively,the patients were evaluated for fracture healing time,clinical outcome of the affected limb and complications in the iliac bone donor area.Results All patients were followed up until fracture healing,and clinical healing was achieved in all patients with a healing rate of 100%and a mean healing time of 5.92 months.No internal fixation failure,such as re-breaking or loosening of the internal fixation occurred in any of the patients during the follow-up period.According to the Tohner-Wrnch criteria,16 cases were excellent,10 cases were good,and 0 cases were poor,with an excellent and good rate of 100%.The complication rate in the autologous iliac bone donor area was 25.00%.Conclusion Revision surgery can be performed by selecting the appropriate internal fixation device according to the original fracture site and the growth of the bone scab.The primary fracture site in the tibial stem is recommended to be fixed by intramedullary pin;the primary fracture site with gradeⅢ,ⅣandⅤbone scabs is recommended to be fixed by anatomical locking splints.Patients with postoperative plate fracture of the lower extremity stem do not routinely required autologous bone grafting routinely during

关 键 词：下肢骨干骨折 钢板断裂 骨痂 翻修手术 

分 类 号：R683.42[医药卫生—骨科学]