前臂骨折内固定术后不愈合原因分析及对策

Analysis and Treatment of Nonunion of Postoperative Focile Fractures

目的探讨前臂骨折内固定术后不愈合的原因,并就不同原因提出相应的治疗方法。方法对26例前臂骨折内固定手术方法和术后处理进行回顾性分析,寻找与骨折不愈合的内在和外在因素关系。对不同情况造成的骨折不愈合给以相应的手术治疗。结果26例44处骨折中9处骨折后局部血液循环受阻,18例肢体活动过早,29处钢板内固定(桡骨18处,尺骨11处)均有力线不正、固定物过短和螺丝钉松动等现象,15处穿针固定(桡骨5处、尺骨10处)存在力线偏差,骨折断端旋转活动。所有病例第二次手术后均获得骨性愈合,无感染、内固定物折断等并发症发生。结论前臂骨折内固定术后不愈合主要原因是骨折后局部血液循环障碍、内固定物选择不当、手术操作不细致、没有结合必要的外固定而术后肢体活动过早。选择合适的内固定物重新有效固定和植骨是处理前臂骨折内固定术后不愈合的有效方法。

Objective To discuss the causes of postoperative focile fracture nonunion and their relevant treatment. Methods 26 cases of postoperative focile fractures were retrospectively analyzed to search for the relationship between operation, postoperative treatment and nonunion. Thereforce, all fractures were treated with relevant operation according to their causes of nonunion. Results 44 fractures in 26 cases had local blood circulation suffocation in 9 cases, extremity motivation before it＇ s time in 18 cases, rnalalignment, fixing material over short or screw loosening in 29 plate fixing cases and malalignment, rotation movement in 15 nail fixing cases. After operation, all cases of fracture gained ostral union without complication. Conclusion The main cause of postoperative focile fracture nonunion is local blood circulation suffocation, fixing material unsuitable, scabrities in operation, lack of combination with needful external fixation and extremity motivation before it＇s time. To reoperate with suitable fixing material and bong grafting is a effective method to treating nonunion of postoperative focile fractures.