骨折术后骨不连的手术治疗研究进展

Research Progress of Surgical Treatment for Bone Nonunion after Fracture Operation

骨折术后骨不连的治疗难度较大。当骨折端出现骨缺损、成骨活性差、生物力学稳定性不足时,保守治疗效果差。手术是治疗骨不连的主要方法,传统手术包括髓内钉动力化、更换内固定、附加钢板等,但骨不连的发病机制复杂,传统手术效果不确切,部分患者需反复手术才能得到愈合。近年来,出现了一些新的治疗方法,如骨移植、牵张成骨技术、联合治疗、组织工程技术等,其中骨移植最常用,组织工程技术最有前景,由于每种方法各有利弊,临床未能形成统一的治疗标准,采用联合治疗,效果更明显。

The treatment of bone nonunion after fracture surgery is extremely difficult.Conservative management always doesn′t work well when bone defect,poor osteogenic activity and unstable biomechanics occur in the fracture end.Surgery plays a key role in the treatment of fracture nonunion.Traditional surgical methods,including interlocking intramedullary nailing and replacement of internal fixation,are more likely to obtain unsatisfied results due to the complex pathogenesis of this disease.Hence,repeated operations must be performed in many cases to gain healing.Recently,some new surgical methods,such as bone transplants,distraction osteogenesis,combined therapy and tissue engineering,have emerged.Among these methods,bone transplants is used most commonly and tissue engineering is the most prospective.Standard treatment is not yet formed because each method has its advantages and disadvantages.Classically,the better therapeutic effect can be acquired if combined treatment is adopted.