股骨髁上骨不连的治疗

Treatment of supracondylar nonunions of the femur

目的探讨动力髁螺钉(dynamic condylar screw, DCS)加自体髂骨移植技术治疗股骨髁上骨不连的疗效.方法 18例股骨髁上骨不连,内固定采用DCS,对严重骨质疏松或骨不连靠近关节面的患者加用髁支持钢板头部;植骨采用自体髂骨,骨移植形式为骨块与碎骨条相结合.术后短期采用术后连续被动活动(CPM)锻炼膝关节功能,持续1年的长期被动与主动锻炼.随访时间12～70个月,平均34个月. 结果所有患者骨不连均治愈,愈合时间为3～6个月,平均5个月.膝关节活动范围从平均73°(5°～135°)增加至平均97°(30°～135°).13例疗效优良,4例满意,1例差. 结论采用具有坚强固定及断端加压作用的DCS,必要时加用多孔髁部固定钢板,结合有效的自体髂骨植骨技术,以及合理的术后长期膝关节功能锻炼,是治疗股骨髁部骨不连的有效方法之一.

Objective To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions. Methods For 18 supracondylar nonunions, DCS was used as the internal fixation device. For patients with severe osteoporosis or with nonunion site close to the artificial surface, the head of the buttress plate was added, making the screws to fixate easily. Iliac bone autograft including iliac block and scum of spongy bone was used in order to fully arouse the inductive and conductive effect of the graft. Continuous postoperative passive motion (CPM) was performed for a short period, and the active and passive motion were intensively advised for one year long. The cases were followed up from 12 to 70 months (mean 34 months). Results All cases were healed, with average healing time of five months (3-6 months). The motion range for the knee joint was increased from 73 degrees (5-135 degrees) to 97 degrees (30-135 degrees). Excellent and good results were achieved in 13 cases, satisfactory in four and poor in one. Conclusion DCS with rigid fixation and compression effect, combined with porous condylar plate if necessary, with iliac bone autograft and long period of postoperative exercises of the knee joint, provides one efficacious technique for treating the supracondylar nonunions of the femur.