锁定钢板内固定治疗四肢骨不连的临床研究

The surgical technique and follow-up of the treatment with locking internal fixation on long bone nonunion of extremities

目的评价锁定钢板内固定治疗四肢长骨骨不连的临床疗效。方法对2003年2月至2006年10月应用锁定钢板内固定治疗61例骨不连患者的临床资料进行回顾性研究。其中男性44例，女性17例；年龄7～70岁，平均38岁。其中5例肱骨骨不连，33例股骨骨不连，23例胫骨骨不连。骨不连的原因包括内固定失效47例，外固定失败5例，感染9例。骨不连病程为10～156个月．平均19个月。42例使用LCP钢板内固定，19例使用LISS钢板内固定。55例采用自体髂骨植骨，3例在自体植骨的同时结合同种异体松质骨移植，3例采用同种异体松质骨结合人工骨移植。手术前、后根据膝关节协会评分系统（KSS）评分对47例膝关节周围骨不连患者的关节功能进行评估，85～100分为优，70～84分为良，60～69分为一般，〈60分为差。术前优29例，良8例，一般4例，差6例。结果所有患者均获得随访，随访时间6～24个月，平均12个月；骨折均在4～6个月内牢固连接，平均愈合时间4．8个月，无内植物松动、断裂等并发症。术后膝关节KSS评分，优35例，良7例，一般1例，差4例。结论锁定钢板内固定结合植骨术是治疗四肢长骨骨不连的有效方法。

Objective To report the outcome of long bone nonunion of humerus, femur and tibia treated with locking internal fixation and bone graft. Methods From February 2003 to October 2006, locking internal fixation and bone grafting were employed to treat 5 cases at hummers, 33 cases at femur, 23 cases at tibia. Forty-four of the patients were men, and 17 were women. The mean age was 38 years （ range 7-70 years）. The nonunion had resulted from failure of internal fixation in 47 cases, failure of external fixation in 5 cases, infection in 9 cases. The history of nonunion lasted from 10 to 156 months （ mean 19 months）. There were 42 patients treated with locking compression plate （LCP）, and 19 patients with less invasive stabilization system （LISS）. For bone grafting, autogenous ilium was used in 55 patients, autogenous ilium and allograft bone was used in 3 patients, allograft bone and Wright DBM artificial bone was used in 3 patients. Results All the 61 patients were followed up for an average 12 months （range 6-24 months） only to reveal solid bone union in all the fracture, with a mean healing time of 4. 8 months （ ranged from 4 to 6 months）. No loosening or breakage of the implants occurred in this series. The Knee Society Scores （KSS） was used to evaluate knee function in 47 patients with peri-knee joint nonunion, excellent result were seen in 35 patients, good in 7 patients, fare in 1 patients, poor in 4 patients. Conclusion Locking internal fixation can be used to treat effectively bone nonunion at the hummers, femur and tibia.