胫骨髓内钉开髓点取骨植骨治疗胫骨骨折不愈合的疗效

CLINICAL OUTCOMES OF AUTOGENOUS CANCELLOUS BONE GRAFTS OBTAINED THROUGH THE PORTAL FOR TIBIAL NAILING IN THE TREATMENT OF TIBIA NONUNION

目的探讨胫骨髓内钉开髓点取骨植骨治疗胫骨骨折不愈合的临床疗效。方法选择2009年3月～2010年9月我科胫骨骨折不愈合51例随机分为两组,对照组断端硬化骨去除后胫骨髓内钉固定,观察组在断端硬化骨去除后使用胫骨髓内钉开髓点的取骨进行植骨及胫骨髓内钉固定。比较两组治疗后患者的骨折愈合及功能情况评价其治疗效果。结果患者获得随访10～14个月(平均12个月),观察组与对照组骨折愈合时间分别为(30.3±0.5)周和(36.1±0.6)周,差异具有统计学意义;患膝关节活动度ROM评分优良率及关节功能HSS评分优良率方面,两组相比差异无统计学意义。结论应用胫骨髓内钉开髓点取骨植骨治疗胫骨骨折不愈合有着更多的优势,值得临床推广。

Objective To evaluate the clinical outcomes of autogenons ancellnus bone grafts obtained through the portal for tibial nailing in the treatment of tibia nonunion. Methods From May 2009 to Sept 2011, fifty - one patients were scheduled to receive IM nailing or had already received IM nailing for the fixation of an ipsilateral tibia shdt fracture. 21 patients who received autogenous cancellous bone grafts obtained from the entry portal of a tibial IM nail for fracture gaps, malalignment or nonunion as study group and 30 patients with tibia nonunion received only tibial IM nailing were selected as a control group. Results The follow - up period ranged from 10 to 14 months （mean 12 months）. All patients had fracture healed and the healing time were （36. 1 ±0. 6）weeks and （30. 3 ±0. 5） weeks respectively in control group and study group, there was significant difference between two groups（p 〈 0. 05 ）. According to ROM, the excellent rate was 90. 5% in the study group, which was not significantly different from 86. 7% of the control group（p 〉 0.05） ;according to Lysholm score and the excellent rate was 85.7% in the study group, which has not significant difference from 83.3 % of the control group （p 〉 0.05 ） at follow - up. Conclusion By using the new technique, autogenous cancellous bone grafting can be performed conveniently and safely to treat fracture gaps, malalignment or nonunion in the lower extremities without additional morbidity at the donor site and worthy to be spread widely.