对腓骨骨板植骨治疗陈旧性骨折骨不连的再认识

Re-evaluation of the effect of autologous fibula plate in treatment of old nonunion of long bone fracture

[目的]对自体腓骨骨板移植单独或联合钢板内固定治疗长骨干陈旧性骨折不连接的临床研究和探讨,评价腓骨骨板植骨治疗陈旧性骨折骨不连的价值。[方法]四肢长骨干骨折不愈合57例,男41例,女16例;年龄20～56岁,平均41.6岁。其中合并短缩畸形18例,平均短缩2.6cm,成角畸形12例;平均成角15°。骨不连时间平均6个月～3年。去除骨不连的两断段硬化骨质,切取适当长度的游离腓骨骨板,用螺丝钉或钢板内固定。[结果]随访时间平均3年(1～6年),手术后1、3、6、12、24个月X线片检查,57例患者骨折全部愈合,平均时间15周(8～24周)。行走或负重等功能良好,无1例发生不愈合。[结论]自体腓骨骨板移植单独或联合钢板内固定治疗长骨干骨折不愈合,可加速骨折愈合,早期功能恢复,仍是治疗四肢长骨干骨折不愈合的理想方法。

[ Objective ] To discuss the technique and outcome in the treatment of old nonunion of long bone fracture by using autologous fibula plate alone or combination with internal fixator plates. [ Method] Fifty -seven patients （41 males and 16 females; average age of 41.6 years ） with nonunion of long bone fracture were recruited. Of them 18 had short deformity（ average 2.6 cm） and 12 had angled deformity（ average 15°） . Average time was 12 months （6 -36 months）. The sclerosed cortex was removed at both ends of the nonunion long bone. A suitable length of fibula plate were transplanted by screw with or without internal fixator plates. [ Result] The follow- up average time was 3 years （ranged, 1 to 6 years） . At 1, 3, 6, 12, 24 months after operation, the outcome was analyzed by radiography. Bone healing was found in all 57 patients, with an average of 15 weeks （8 -24 weeks）. All the patients exhibited a good function in walking and burdening. No nonunion occurred. [ Conclusion] Autologous fibula plate with or without internal fixator plates for nonunion of long bone fracture can facilitate healing and early functional recovery. This therapeutic method is an ideal technique in treating patients with nonunion of long bone fracture.