骨皮质剥离加Phemister植骨治疗内固定术后骨不连、骨延迟愈合

Treatment of bone nonunion and delayed union after internal fixation by bone cortex stripping combined with Phemister bone graft

目的 探讨骨皮质剥离加Phemister植骨治疗内固定术后骨不连、骨延迟愈合的临床效果.方法 选择2006年2月～2012年10月采用骨皮质剥离加Phemister植骨的方法治疗的四肢长骨干骨折内固定术后骨不连、骨延迟愈合患者12例.根据骨折部位不同,植骨前分别采用锁定钢板内固定术及交锁髓内钉内固定术.对患者术后情况进行随访,统计患者骨折愈合情况及关节功能情况.结果 本组12例患者均获随访,随访时间5～38个月,平均23个月.骨折均骨性愈合,无感染、骨髓炎、骨化性肌炎,内固定松动、钉板断裂等并发症发生.本组12例患者中9例骨关节功能为优,肱骨骨折1例（肩、肘）,尺、桡骨骨折4例（肘、腕）,胫骨骨折2例（膝、踝）,股骨骨折2例（膝）;良2例,1例桡骨骨折患者腕关节功能为良,1例胫腓骨骨折患者膝关节功能为良;1例胫骨骨折患者踝关节功能差.骨折植骨术后各关节功能优良率为91.7％（11/12）.结论 骨皮质剥离加Phemister植骨治疗内固定术后骨不连、骨延迟愈合均获骨性愈合,关节功能良好,疗效满意.

Objective To investigate the clinical curative effect of bone cortex stripping combined with Phemister bone graft in the treatment of bone nonunion and delayed union after internal fixation.Methods 12 cases of bone nonunion and delayed union after limbs long bone fracture internal fixation treated by bone cortex stripping combined with Phemister bone graft from February 2006 to October 2012 were selected.Locking plate internal fixation and interlocking intramedullary nail internal fixation were used before bone graft according to different fracture sites.Postoperative situation was followed-up,fracture healing and joint function were counted.Results 12 cases were followed up,and the follow-up time was 5-38 months,the average were 23 months.The fracture was bone healing,no infection,osteomyelitis,myositis ossificans,internal fixation loosening and nail plate fracture were found.9 cases with excellent joint function were found in 12 cases,1 case of humeral fracture （shoulder,elbow）,4 cases of ulna,radius fracture （elbow,wrist）,2 cases of tibia fracture （knee,ankle）,2 cases of femoral fracture （knee） were found; 2 cases with fine joint function were found in 12 cases,1 case of radius fracture with fine wrist joint function and 1 case of tibia fracture with fine knee joint function were found.1 case of tibia fracture with poor ankle joint function was found.The rate of good joint function after bone graft was 91.7％ （11/12）.Conclusion The cases who has postoperative bone nonunion and delayed union after internal fixation treated by bone cortex stripping combined with Phemister bone graft all are osseous healed,and they have good joint function,the curative effect is satisfied.