外固定器结合植骨治疗尺桡骨骨折内固定术后骨不连

Unilateral external fixation combined with bone graft for treating nonunion of ulnar and radial fractures failed with internal fixation

目的:探讨单侧外固定器结合植骨治疗尺桡骨骨折内固定术后骨不连的方法及疗效。方法:应用单侧外固定器结合植骨治疗29例尺桡骨骨折钢板和三棱针内固定术后骨不连,其中男19例,女10例;年龄18-60岁,平均28岁。尺骨14例,其中近段4例,中段7例,远段3例;桡骨15例,其中近段4例,中段6例,远段5例。开放性骨折8例,闭合性骨折21例。粉碎性骨折14例,斜形骨折6例,横形骨折9例。结果:全部病例随访6-23个月,平均手术后16周(13-24周)骨折愈合。肘关节活动度均超过屈130°、伸0°,腕关节活动度均达掌屈60°、背伸50°以上;22例前臂旋转功能旋前、旋后均达80°以上,1例旋前40°,1例旋后50°,2例旋前、旋后均受限,总活动度仅80°。术后无尺、桡骨间骨性融合。结论:单侧外固定器结合植骨治疗前臂骨折内固定术后骨不连是一种操作简便,创伤小,固定牢固并发症少的有效方法,治疗期间可早期功能活动。

Objective： To analyze the method and result of unilateral external fixation combined with bone graft for treating nonunion ulnar and radial fractures failed with internal fixation. Methods： Twenty-nine patients with nonunion of ulnar and radial fractures after internal fixation of plate and triangle-edged needle included 19 male and 10 female with the average age of 28 years ranging from 18 to 60 years. There were 14 cases of ulnar fracture involving 4 cases in proximal,7 in midpiece and 3 in distal; 15 of radial fracture involving 4 in proximal ,6 in midpiece and 5 in distal. There were 14 cases of comminuted fracture,6 of oblique fracture,9 of transverse fracture. Results： All cases were followed-up for 6 to 23 months. All nonunion fractures united within an average of 16 weeks ranging from 13 to 24 weeks. The motion of elbow joint flexed over 130° and extended over 0°. The motion of wrist joint reached 60° of palmar flexion and 50°of back extend. The rotation function of forearm in 22 cases reached 80° on pronation and supination. The pronation of 1 case reached 40° ,the supiration of 1 case reached 50°, both the pronation and supination of 2 cases were limited, the total range of motion was 80°. No bone fusion between ulnar and radius occurenced after operation. Conclusion： Fixation by external fixation with bone graft is a reliable and effective treatment for nonunion of ulnar and radial fractures failed with internal fixation.