附加钢板联合髂骨植骨治疗长骨髓内钉固定后骨不连

Combined augmentative plate fixation with bone graft in treatment of long bone nonunion secondary to intramedullary nailing fixation

目的探讨附加钢板联合自体髂骨植骨治疗髓内钉固定后骨不连的临床疗效。方法应用附加钢板治疗髓内钉固定后长骨干骨不连17例,其中男12例,女5例,年龄28-65岁,平均47.6岁。骨不连发生的部位：股骨9例,胫骨6例,肱骨2例。10例为肥大型骨不连,7例为萎缩性骨不连。手术均采取保留髓内钉,骨折断端清理,取自体髂骨植骨,附加锁定钢板单皮质固定。结果本组患者随访时间12-24个月,平均15.3个月,17例均获得骨性愈合,愈合时间4-8个月,平均5.3个月,无切口并发症,无钢板螺钉松动、断裂。结论使用附加锁定钢板联合自体髂骨植骨是治疗髓内钉固定后骨不连的有效方法之一,具有创伤小、患者术后恢复快的优点。

Objective To explore the clinical effect ofcombined augmentative plate fixation with bone graft in the treatment of long bone nonunion secondary to intramedullary nailing fixation. Methods Seventeen long bone fractures nonunion secondary to intramedullary nailing fixation were operatively treated in our hospital. There were 12 males and 5 females,with an average age of 47. 6 years old（ range 28 to 65 years old）. There were 9 patients in femor,6 in tibia and2 in humerus. Of there,10 patients were hypertrophic nonunion and 7 patients were atrophic nonunion. All of the nonunion were treated by debridement,locking plate fixation and a sufficient amount of cortical bone grafting,without intramedullary nail removing. Results All patients were followed up and the average duration of follow-up was 15. 3months（ range 12 to 24 months）. All the fractures got bone union. Fracture healing time was 4-8months with an average of 5. 3months. No complication occurred in incision and fixation failure. Conclusion Combined augmentative locking plate fixation with bone graftis a safe and effective method for the treatment oflong bone nonunion secondary to intramedullary nailing fixation.