附加钢板治疗髓内钉固定后肥大型骨不连

Augmentative plate fixation to treat hypertrophic nonunions subsequent to intramedullary fixation

目的探讨应用附加钢板治疗髓内钉固定后肥大型骨不连的方法及临床疗效。方法1998年1月～2005年8月，应用交锁髓内钉治疗长骨干骨折386例，其中7例出现肥大型骨不连，男5例，女2例；年龄21～48岁，平均32．6岁。发生部位：肱骨2例，胫骨1例，股骨4例。2例开放性骨折，5例闭合性骨折，受伤至骨不连手术时间平均为9．5个月（6～18个月）。钢板置于骨干旁侧偏前或偏后，螺钉经髓内钉旁穿至对侧骨皮质，骨折两端各用2～3枚螺钉固定。对骨折间隙大于0．5cm者行自体髂骨植骨，小于0．5cm者予植入固髂生。结果7例患者均在术后4～10个月（平均7个月）出现骨性愈合。X线片显示连续性骨痂通过骨折线或骨折线消失。无感染、内固定断裂及松动等并发症发生。结论通过附加钢板改善骨折局部的稳定性是纠正肥大型骨不连的有效方法。该方法简便、损伤小、花费少、疗效确实，是治疗髓内钉固定后肥大型骨不连的可靠方法。

Objective To investigate the effect of augmentative plate fixation to increase stability in treatment of bone shaft nonunioas subsequent to intramedullary fixation. Methods Three hundred and eighty six cases of the bone shaft fractures were treated with intramedullary nailing from January 1998 to August 2005. Of them, 7 cases （5 males and 2 females） developed hypertrophic nonunion. Their average age was 32.6 years （range, 21 to 48 years）. The nonunion was located at the humerus in 2 cases, at the tibia in 1 case, and at the femoral shaft in 4 cases. Two cases were open fractures and 5 cases closed ones. The delayed time from injury to surgery for nonunion averaged 9.5 months （range, 6 to 18 months）. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of the bone shaft. Results All cases obtained union within 7 months （range, 4 to 10 months）. Their hardware was removed in 6 to 14 months after operation in all the cases but one pregnant woman. No infection, hardware loosening or breaking was found. Conclusions The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability which is thought to be a cause of hypertrophic nonunion. The augmentative plate fixation is a useful and simple treatment for the hypertrophic nonunion of the bone shaft fracture after intramedullary nailing.