解剖型锁定钢板内固定结合自体髂骨植骨治疗胫骨骨折术后骨不连效果

LOCKING ANATOMIC PLATES COMBINED WITH AUTOLOGOUS BONE GRAFT FOR NONUNION AFTER SURGERY FOR TI-BIA FRACTURE

目的探讨胫骨骨折术后骨不连的成因,以及解剖型锁定钢板内固定结合自体髂骨植骨术治疗的临床效果。方法对13例胫骨骨折术后骨不连病人的临床资料进行回顾性分析。13例病人中,男9例,女4例;年龄19～64岁,平均39岁。骨不连类型:肥大型7例,萎缩型4例,假关节型2例。本次手术时间与上次手术时间平均间隔9.4个月(9.1～9.7个月)。所有病人均行切开复位、取出原有内固定物、自体髂骨植骨、解剖型锁定钢板固定治疗。结果 13例病人术后获得9～24个月(平均13个月)的随访,术后2个月左右骨折端周围出现新鲜骨痂,骨不连均在术后4～12个月(平均6个月)牢固愈合。13例病人术后骨不连均获得愈合,无感染、内固定物松动及断板、断钉等并发症发生。结论胫骨远、近端解剖型锁定钢板内固定结合自体髂骨植骨可以明显促进骨折愈合,是治疗胫骨骨折术后骨不连的有效方法。

Objective To investigate the causes of postoperative nonunion of tibia fractures and clinic effect of locking compression plates （LCP） combined with autologous iliac bone grafting for this condition. Methods A retrospective review of 13 patients with postoperative nonunion for tibia fracture was done. Of those, nine were men, and four were women, with ages （mean） 19--64 （39） years. The types of nonunion were： seven with hypertrophic nonunion, four with atrophic nonunion and two with pseudarthrosis. The mean （range） interval between this operation and last-time one was 9.4 （9.1- 9.7） months. All the pa- tients underwent open reduction, removal of previous fixities, autologous iliac bone grafting and internal fixation with LCP. Re- sults All the patients were followed up for a mean （range） of 13 （9--24） months. Fresh bony callus was seen around the tips of fractures about two months after surgery, and all of the nonunion firmly healed 4--12 months after surgery, without complica tions-such as infection, loosening of internal fixity, break down of plate or nail. Conclusion Combination of locking compression plates with autologous iliac bone grafting can obviously improve fracture healing, which is an effective treatment for nonunion after surgery for tibia fractures.