骨折不愈合与延迟愈合的成因与治疗

Causes and treatments of non-union and delayed union of fractures

目的探讨骨折不愈合与延迟愈合的成因,报告治疗的方法与效果。方法对1990年7月～2004年12月间收治的107例骨折不愈合、54例骨折延迟愈合和2例先天性胫骨骨不连进行回顾性研究,分析原因,随访治疗结果。18例延迟愈合行保守治疗,本组其他145例行手术治疗。结果除2例先天性胫骨骨不连外,其余161例的成因中均有医源性因素。10例失去随访,153例平均随访17(6～28)个月,骨折均获骨性连接;愈合时间平均10(6～14)个月,肢体功能恢复良好。结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因,针对各种不同因素进行合理治疗可获得满意效果。

Objective To investigate the causes of non-union and delayed union of fractures and to report the surgical techniques and outcomes of the treatments. Methods 107 cases of non-union, 54 cases of delayed union and 2 cases of congenital non-union of tibia were treated between July 1990 and December 2004 in our hospital. The treatments were evaluated retrospectively to analyze the causes of the disorder and the treatment outcomes at the follow-up. 18 cases of delayed union were treated conservatively while the other 145 cases in this series underwent surgery. Results Except in the 2 cases of congenital non-union of tibia, iatrogenic factors were found to be responsible for nonunion or delayed union in all the other 161 cases. 153 cases were followed up for an average of 17 (6 to 28) months only to reveal bone union in all the cases with a mean healing time of 10 (6 to 14) months. All the limbs regained good function. Conclusion Since development of non-union and delayed union of fractures chiefly result from iatrogenic technical defects, satisfactory results can be achieved as long as appropriate treatments are performed according to different etiological factors.