应用原位骨痂骨膜瓣治疗股骨干骨折髓内钉术后骨折不愈合

TREATMENT OF FEMORAL SHAFT FRACTURE NONUNION WITH BONE CALLUS IN SITU OSTEOPERIOSTEAL FLAP

目的探讨应用原位骨痂骨膜瓣结合自体髂骨植骨治疗股骨干骨折髓内钉固定术后骨折不愈合的疗效。方法回顾分析2006年2月—2009年12月收治的68例股骨干骨折带锁髓内钉术后骨折不愈合患者,采用原位骨痂骨膜瓣结合自体髂骨植骨治疗,手术采用外侧切口,骨折端周围骨膜连同增生骨痂保留,向两侧葱皮样直接掀起,使与周围软组织相连,形成原位骨痂骨膜瓣,保留血运,清理骨折端的纤维组织及硬化骨。48例取出原有髓内钉,更换粗髓内钉重新固定。20例未更换原有髓内钉直接附加外侧钢板固定。所有患者均取自体髂骨植于骨折端后将原位骨痂骨膜瓣包于植骨外侧。术后不负重或部分负重功能锻炼,骨折愈合后完全负重。结果 68例均得到随访,随访时间8～16个月,骨折全部愈合,愈合时间3～12个月,平均4个月,术后肢体活动良好。结论原位骨痂骨膜瓣结合自体髂骨植骨治疗股骨干骨折髓内钉固定术后骨折不愈合的效果可靠,术后功能恢复良好,值得推广应用。

Objective To evaluate the effect of bone callus in situ osteoperiosteal flap with autologous iliac bone graft in treatment of femoral shaft fracture secondary to intramedullary nailing. Methods Sixty -eight cases of femoral shaft fracture nonunion after interlocking intramedullary nailing from Febrary 2006 to December 2009 were retrospectly analysed. All patients were treated by bone callus in situ periosteal flap and autologous iliac bone graft. The lateral incision was applied. The periosteum around the fracture site and the proliferation of callus were dissected to both sides just like the onion skin, aiming to form a callus perlosteal flap in situ whose blood supply was retained. And then, the fibrous tissue and harden bone in fracture site were cleaned carefuUy. The original intramedullary nails of 48 cases were taken out and replaced by the thicker intramedullary nails. The direct - attached lateral nail plate were applied in other 20 cases with original intramedullary nails kept in situ. The iliac bones were grafted to fracture nonunion site keeping fracture callus periosteal flap bag outside of the bone in all cases. Non- weight- bearing or partial weight -bearing functional exercises were applied postoperation and full weight - bearing exercises were applied after fracture healing. Results All the 68 cases were followed up for 8 - 16 months . All fractures healed up with a good physical activity. The healing time was 3 - 12 months, an average of 4 months. Conclusion Bone callus in situ osteoperiosteal flap with autologous iliac bone graft in treatment of femoral shaft fracture nonunion secondary to intramedullary nailing was a reliable and effective method with satisfactory functional recovery.