锁定钢板治疗髓内固定失败致无菌性骨不连

Treatment of aseptic non-unions after intramedullary nailing interfixation with locking plate

目的评价锁定钢板治疗因髓内钉固定失败而造成的无菌性骨不连的疗效。方法2004年1月至2006年12月，因髓内钉固定失败而造成的四肢长骨无菌性骨不连患者38例，男26例，女12例；年龄9-70岁，平均39．2岁；骨不连时间6-84个月，平均16．2个月。按骨不连骨折端形态Judet分类法分型：肥大型9例，营养不良型10例，萎缩型19例，其中15例形成假关节。骨不连的部位：股骨20例，胫骨15例，肱骨3例，其中21例（占55.3％）位于长骨干骺端附近。该组病例均采用锁定钢板固定以及联合骨移植进行治疗。结果患者均获得随访，随访时间昏．20个月，平均11．6个月。骨不连均愈合，愈合时间4-8个月，平均5.3个月。3例（7．9％）出现切口表面感染，经治疗后均痊愈；1例（2．6％）切口延迟愈合；1例（2．6％）出现肢体短缩约2cm。无一例发生骨折畸形愈合。末次随访时关节活动度较术前显著改善，其中30例（78．9％）功能优良，7例（18.4％）可，1例（2．6％）差。结论对于髓内钉固定失败而造成的无菌性骨不连，采用锁定钢板进行固定是一种疗效确切的治疗方法，尤其是针对干骺端附近的骨不连。锁定钢板联合骨移植治疗能提供可靠的固定稳定性和骨诱导、骨传导作用。

Objective To evaluate the clinical outcomes of locking plate to treat aseptic non-unions after intramedullary nailing interfixation. Methods From January 2004 to December 2006, a total of 38 consecutive patients with long bone non-unions at extremities after intramedullary nailing interfixation were treated. There were 12 females and 26 males with a mean age of 39.2 years （range 9-70 years） and with a mean time of non-union 16.2 months （range 6-84 months）. There were 9 hypertrophic non-unions, 10 malnourished non-unions and 19 atrophic non-unions according to Judet classification of non-union morphous. And there were 15 synovial pseudarthrosises in those cases. The non-unions happeded in femurs 20 patients, tibias in 15 and humeruses in 3. 21 （55.3%） of them were located nearby the metaphyseal of the long bones. Patients were treated with locking plate combinating with bone grafting for the non-union of intramedullary nailing. The postoperative outcomes and joint functions of all patients were clinically evaluated. Results All patients were followed up for a mean time of 11.6 months （range 6-20 months）, and the nonunions healed after a mean 5.3 months （range 4-8 months） in all of the 38 patients. Only 3 cases （7.9%） suffered infected in superficial of the incision and one case （2.6%） delayed healing of incision. 1 case occured shortening in the leg about 2 cm. No malunion and any other further complications were found. For the function of joints, 30 patients （78.9%） were excellent or good, 7 patients （18.4%） were fair and 1 patient （2.6%） was poor by re-evaluating through a mean follow-up of 11.6 months. Conclusion It has been shown that locking plate is an effective treatment for aseptic non-union after intramedullary nailing interfixed, especially in the area of the metaphyseal. And it can provide reliable stability and excellent osteoinductive and osteoconductive when it combined with bone graftings.