下肢骨干骨折髓内钉术后非感染性骨不连的原因分析及临床疗效观察

Cause Analysis and Clinical Effect of Aseptic Shaft Nonunion of the Lower Extremities after Intramedullary Nailing

目的探讨下肢骨干骨折髓内钉术后非感染性骨不连的原因,并观察扩髓保留髓内钉联合附加侧板用于骨不连的临床疗效。方法选取2010年5月—2016年8月中江县人民医院收治的下肢骨干骨折髓内钉固定术后非感染性骨不连患者86例,随机分成对照组与研究组,各43例。对照组运用更换髓内钉治疗,研究组采用扩髓保留髓内钉联合附加侧板治疗,比较分析两组临床疗效。结果研究组患者的手术时间、术中出血量、术中输悬浮红细胞量均低于对照组,差异有统计学意义(P<0.01);研究组与对照组术后引流量与住院时间比较,差异无统计学意义(P>0.05)。两组患者切口均属于Ⅰ期愈合,无血管与神经损伤等发生。治疗后,两组患者未出现感染、畸形愈合与患肢功能障碍等并发症。两组随访时间为12~24个月,平均16.5个月。两组患者骨折均愈合,其中研究组患者的临床骨愈合时间与影像学骨愈合时间短于对照组,差异有统计学意义(P<0.01)。末次随访研究组临床疗效优良率高于对照组,差异有统计学意义(P<0.05)。结论扩髓保留髓内钉联合附加侧板治疗下肢骨干骨折髓内钉术后非感染性骨不连的效果优于更换髓内钉,此法操作简单、手术时间短、临床效果显著,是治疗非感染性骨不连的首选方法。

Objective To analyze the causes for aseptic shaft nonunion of the lower extremities after intramedullary nailing and to observe the therapeutic effects on bone nonunion by the combined technique of intramedullary nail retention with augmentation plating. Methods 86 cases of aseptic shaft nonunion of the lower extremities after intramedullary nailing patients were selected from Deyang County People’s Hospital from May 2010 to August 2016. All patients were randomly divided into the control group（ n = 43） and the study group（ n = 43）. The control group were treated with intramedullary nail retention with augmentation plating, the study group were treated with intramedullary nail exchanging, and the therapeutic effects were compared and analyzed. Results The operation time,blood loss,volume for suspended red blood cells transfusion in the study group were lower than that in the control group（ P 〈 0. 01）. There was no significant difference in postoperative drainage volume and hospitalization days between two group（ P 〉 0. 05）. All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 16. 5 months on average（ range,12-24 months）. During follow-up,no following complication occurred in both group： infection,malunion and limb dysfunction. All cases obtained bone union,and time of clinical and radiological bone healing in the study group was significantly shorter than those in the control group（ P 〈0. 01）. At the end of the follow-up,the excellent and good rate of the study group was higher than that in the control group,the differences were statistically significant（ P 〈 0. 05）. Conclusion Intramedullary nail retention with augmentation plating is an the optimal method for aseptic shaft nonunion of the lower extremities after intramedullary nailing and can achieve satisfactory clinical outcomes because it has simpler operation,shorter operation time.