自体髂骨植骨治疗尺骨远端缺损性骨不连的临床研究

Clinical study on treatment of the ununited distal ulnar fracture with osseous defects:autogenous iliac bone-grafting

目的探讨自体髂骨植骨治疗尺骨远端缺损性骨不连的疗效。方法2002年8月至2006年5月应用自体髂骨植骨和钢板固定治疗尺骨远端缺损性骨不连21例，尺桡骨双骨折引起的骨不连13例（AO／ASIF分型23-A3型8例；23-B3型5例），单纯尺骨骨折引起的骨不连8例（A0／ASIF分型23-A3型3例；23-B3型5例）。首次发病开放性骨折15例（Gustillo和Anderson分级1级11例；2级4例），闭合性骨折6例。骨缺损1．5-5.0cm，平均3.1cm。术后每个月随访一次，观察临床表现和X线片。结果21例患者随访7-29月，平均14，7月，所有患者均骨性愈合，愈合时间3～7月，平均4．6月。19例对位对线良好，一例冠状面成角〈100，另一例矢状面成角150。Anderson评分：优8例（38.1％），良11例（52.4％），差2例（9．5％），优良率90.5％。结论自体髂骨嵌入式植骨和坚强固定，术中彻底清创骨不连，重建尺骨长度和矫正畸形治疗尺骨远端缺损性骨不连是一种疗效明显的方法。

Objective To discuss autogenous iliac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. Methods From August 2002 to May 2006,21 cases of the ununited distal ulnar fracture with osseous defects were treated with autogenous iliac bone-grafting and plate fixtion in our department. There were 13 cases of nonunion resulted from the radial and ulnar fracture initially （AO/ASIF classification： 8 of 23- A3 type;5 of 23- B3type）, 8 cases of nonunion from the ulnar fracture initially （AO/ ASIF classification ：3 of 23 - A3 type;5 of 23 - B3 type）. There were 15 initial cases of open fracture （ 11 of Gustillo and Anderson Grade 1 ;4 of Grade 2） and 6 of closed fracture. A segmental osseous defect with an average size of 3.1 cm （range, 1.5 to 5.0 cm） was present in each patient. Follow-ups were conducted once per month to observe clinical appearances and radiography in patients. Results All the cases were followed up for an mean time of 14.7 months （range, 7 to 29 months）. All the patients obtained bony union, an mean time of 4.6 months（range,3 to 7 months）. The distal ulnar healed with 〈 100 of angular deformity in a lcoronal plane in one patient and with 150 of angulation in a sagittal plane in another one, while others obtained satisfactoryalignment. Anderson score： excellent in 8 cases （ 38.1% ）, good in 11 （9.5 % ）. Conclusion Conclusion There is an effect technique in treating osseous defects by intercalary bone-grafting with autogenous iliac and nonunion site, restoration of ulnar long, correction of defomaities cases （ 52.4 % ）, poor in 2 cases the ununited distal ulnar fracture with secure fixation, good debridment in nonunion site, restoration of ulnar long, correction of deformities.