附加锁定加压钢板联合植骨治疗股骨干骨折髓内钉固定术后无菌性骨不连

Augmentative locking compression plate(LCP) combined with bone graft for the treatment of aseptic femoral shaft nonunion after intramedullary nailing

目的：探讨附加锁定加压钢板联合植骨治疗股骨干骨折髓内钉固定术后无菌性骨不连的手术方法及临床疗效.方法：2007年1月至2013年1月,收治股骨干骨折髓内钉固定术后无菌性骨不连患者21例,其中男18例,女3例;年龄23 ～64岁,平均37.7岁;骨不连时间9～62个月,平均（23.9±15.6）个月;根据Weber-Cech分型：肥大性骨不连10例,萎缩性骨不连7例,营养不良性骨不连4例.均不取髓内钉,断端切新、取自体骼骨植骨,附加6～8孔锁定加压钢板,近端及远端各拧入2～3枚单皮质锁钉固定.术后根据影像学结果部分负重直至完全负重,定期门诊随访进行临床及影像学评估.结果：21例患者均获得随访,时间8～24个月,平均（13.5±3.5）个月.所有患者获骨性愈合,临床愈合时间4～8个月,平均（6.0±1.0）个月;影像学愈合时间7～12个月,平均（9.1±1.5）个月.术后无感染,内固定松动、断裂等并发症发生.结论：附加锁定加压钢板联合植骨治疗股骨干骨折髓内钉固定术后无菌性骨不连的疗效满意,是一种简便、有效的方法.

Objective：To investigate the effect of augmentative locking compression plate combined with bone graft in treating aseptic femoral shaft nonunion after intramedullary nailing.Methods：Twenty-one cases with aseptic femoral shaft nonunion after intramedullary nailing from January 2007 to January 2013 were treated,including 18 males and 3 females with a mean age of 37.7 years （ranged from 23 to 64 years）.The mean period of nonunion after surgery was 23.9 months （ranged from 9 to 62 months）.According to Weber-Cech classification,10 of those 21 cases were hypertrophic nonunion,7 were atrophic,and 4 had oligotrophic fracture nonunion.All patients retained the original intramedullary nail,and applied with augmentation plating of 6 to 8 holes locking compression plate,unicortical fixation with 2 to 3 locking screws in the proximal or distal end,with simultaneous autologous iliac bone grafting.After treatment,all patients were allowed to partial weight-bearing until full weight-bearing according to the radiological results.All patients were followed up and were evaluated with clinical and imaging results.Resuts：All patients were followed up from 8 to 24 months,averaged （13.5±3.5） months,which showed clinical union at 4 to 8 months,averaged （6.0±1.0） months and radiological solid union at 7 to 12 months,averaged （9.1±1.5） months.No such complications as infection,hardware loosening or breaking were found.Conclusion：Augmentative locking compression plate（LCP） combined with bone graft for aseptic femoral shaft nonunion after intramedullary nail has a satisfied clinical efficacy.It＇s an useful and simple method.