280例骨不连病例原因分析

Cause analysis of 280 case of fractures nonunion

目的:通过对大宗骨不连病例的临床资料回顾性研究,以求发现骨生长能力低下的原因。方法:1999年10月至2009年4月,对280例骨不连病例进行回顾性研究,男230例,女50例;年龄19～62岁,平均39.4岁。股骨129例,胫骨83例,肱骨47例,尺桡骨21例。调查内容包括原发损伤经过及损伤程度,首次治疗情况包括首诊医院级别、首次手术时机、早期骨痂生长状况、是否有明显的技术错误。结果:股骨骨不连资料完整者129例,源于闭合骨折121例,开放骨折8例。无菌性骨不连111例。90%早期无明显骨痂生长,首次治疗80%为伤后当天手术内固定,10%为伤后3d以内手术,总计90%为早期手术。结论:骨痂生长能力低下是当前骨不连的重要原因,早期手术与骨痂生长能力低下有很大的相关性。在内固定如此发达的时代仍然存在较多不明原因的骨不连,这一现象似乎与内固定手段无关,而与骨生长能力低下有关。

Objective ： To research many clinical data of nonunion cases and discover the reasons for low capacity of bone growth. Methods： From October 1999 to April 2009 ,the source material of 280 nonunion cases were conducted and followed up. The data of the study included 230 males and 50 females ,with an average age of 39.4 years old ranging from 19 to 62 years. The fracture position was femur in 129 cases ,tibia in 83 cases,humerus in 47 cases ,feet radius bone in 21 cases ,the ratio was 46：29.6：16.8：7.5. The survey included primary injury process, damage degree and the effect of first treatment, hospital level of first treatment, timing of surgery for the first time, the early callus growth conditions and whether there were obvious technical errors. Results：There were 129 femoral nonunion cases with complete data, 121 cases derived from closed fractures,8 cases from open fractures ; 111 cases was aseptic nonunion. 90% of femoral aseptic nonunion had no obvious callus growth, 80% of first treatment performed intraday surgical internal fixation, 10% were undergone operation within three days and 90% was ear ly surgery totally. Conclusion： Low quality of bone callus growth is the main reason for current nonunion and the early surgical fixation has much to do with low quality of bone callus growth.