金属植入物内固定治疗四肢骨折后的骨不连

Metallic implant internal fixation for the treatment of nonunion following extremity fracture

背景:骨折的愈合除了与骨折类型、骨折局部血运及感染等因素有关之外,还与内固定物的选择、使用及规范操作有着很大的关系。目的:分析不同植入物内固定治疗四肢骨折后出现骨不连的原因,并探讨有效的治疗方法及合适的内固定物选择方案。方法:由第一作者采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索2000-01/2010-05有关骨折内固定后骨不连及治疗骨不连的研究文章,关键词为"骨折,内固定,骨不连"。排除重复研究或Meta分析类文章,筛选纳入25篇文献进行深入分析。结果与结论:四肢骨折内固定后骨不连的发生率除了与骨折类型、骨折断端血运以及感染等因素有关之外,还与操作技术,尤其是内固定物选择以及内固定的使用方式有直接关系。对于许多骨折,如何针对骨折的类型,选择合适的内固定物以及准确的操作技术是维持内固定物长久有效性、促进骨折愈合的重要因素。虽然由于受伤机制的不同,四肢骨折会有许多复杂的类型,并对骨折愈合有一定的影响,但随着骨折内固定材料的不断推陈出新,对不同部位、不同类型的骨折有着越来越多针对性的固定方式。内固定物的选择及使用方式的准确与否,对于骨折内固定后的愈合有着很大的影响。

BACKGROUND：Besides fracture pattern,local blood supply and infections,selection,utilization,as well as standard operation of internal fixation also affect bone union.OBJECTIVE：To analyze the causes of nonunion following internal fixation for the treatment of extremity fracture,and to explore the effective treat methods and selection of suitable internal fixation.METHODS：Wangfang data was retrieved by the first author using key words of ＂bone fracture,internal fixation,nonunion＂ for papers addressing bone nonunion after internal fixation and treatment methods published between January 2000 and May 2010.Totally 25 documents were analyzed after removing repetitive studies or Meta analysis.RESULTS AND CONCLUSION：Incidence of nonunion after extremity fracture is related to operation technique except fracture pattern,local blood supply and infections,especially,has directly association with selection and utilization of internal fixation.How to select pertinent internal fixation and accurate fix it is an important factor affects long-term efficacy of fixation and promote bone union.Extremity fractures are complex due to various injury mechanisms and have effect on bone union.Accordingly,matched internal fixations are designed for different fractures types and positions.The selection and utilization of internal fixation affect bone union greatly.