胫骨骨折术后骨不连原因分析及治疗措施

Cause Analysis of Postoperative Nonunion of Tibial Fracture and Its Treatment Strategies

目的探讨胫骨骨折术后骨不连的原因及治疗措施。方法对我院收治的胫骨或胫腓骨骨折内固定术后骨不连112例的临床资料进行回顾性分析。结果本组8例失访,余104例随访18~48个月,平均30个月,愈合98例,愈合率为94%,平均愈合时间9.2个月。104例患肢膝、踝关节功能均恢复良好,其中交锁髓内针静力固定改为动力固定及改用交锁髓内针固定各1例,术后仍然骨不连,取出交锁髓内针,行自体髂骨植骨、Ilizarov外固定架固定治疗后愈合。结论创伤严重、医源性损害、感染、不合理康复训练、营养状况、吸烟是导致胫骨骨折术后骨不连的重要原因,根据具体情况选择合适治疗方法可达到满意效果。

Objective To investigate the cause of postoperative nonunion of tibial fracture and its treatment measure.Methods The clinical data of 112 tibial or tibiofibula fracture patients with postoperative nonunion were retrospectively analyzed.Results The follow-up of 8 patients was lost,and 104 were followed up for 18~48 months（average 30 months）,among whom,98（94%） were healed with an average healing time of 9.2 months.Functions of knee and ankle joint recovered in 104 patients,among whom,interlocking intramedullary nail static fixation was displaced by dynamic internal fixation in 1 and displaced by interlocking intramedullary nail fixation in 1.Both also had nonunion after the operation,then they underwent autogeneic ilium bone graft after dislodging the interlocking intramedullary nails.The fractures in the two patients were healed after Ilizarov external fixation treatment.Conclusion Serious trauma,iatrogenic damage,infection,poor rehabilitation training,nutrition level,and smoking are mainly factors of postoperative nonunion in tibial fracture patients.Appropriate choice of treatment method can achieve a satisfactory result according to the specific conditions.