附加钢板联合断端清理去皮质化植骨治疗股骨干骨折髓内钉术后无菌性骨不连

Clinical effect of additional locking plate fixation together with decorticated bone grafting in treatment for femoral shaft aseptic nonunion subsequent to failed intramedullary nailing

目的探讨附加钢板联合断端清理去皮质化植骨治疗髓内钉术后无菌性骨不连的临床疗效。方法回顾性分析2013年1月至2017年8月期间山东大学齐鲁医院急诊外科收治的40例股骨干骨折髓内钉治疗后无菌性骨不连的患者资料。所有患者均采用骨折断端清理、去皮质化、取自体髂骨植骨及附加单皮质锁定钢板治疗。术后随访观察切口愈合、疼痛、关节功能及骨折愈合情况等指标。结果所有患者术后均获得随访,平均随访时间为15(12~18)个月。治疗效果优良率100%(优37例,良3例)。所有患者下地负重行走时主观疼痛症状消失,患肢功能恢复良好,均无切口感染和内固定物疲劳断裂发生。所有患者疼痛视觉模拟评分由术前(6.0±1.1)分降至术后末次随访时(2.0±1.3)分(P<0.05)。末次随访时患者均获得骨性愈合,平均愈合时间8.5(5.5~14.5)个月。经X线或CT证实,均未发现螺钉及钢板松动断裂及感染等并发症。结论附加钢板联合断端清理去皮质化植骨治疗股骨干骨折髓内钉固定术后无菌性骨不连疗效确切、可靠,是一种有效的治疗股骨干无菌性骨不连的手术方式。

Objective To investigate the clinical effect of additional locking plate fixation together with decorticated bone grafting in treatment for femoral shaft aseptic nonunion subsequent to failed intramedullary nailing.Methods A retrospective study was conducted on 40 cases of aseptic nonunion of femoral shaft fracture treated with intramedullary nail in Department of Emergency Surgery,Qilu Hospital,Shandong University from January 2013 to August 2017.All patients were treated with debridement of fracture sites,decortication,autogenous iliac bone grafting and additional locking plate.All patients were followed up for at least 12 months.The incision healing,pain,joint function and fracturehealing was observed in 1,2,3,6,12 and 18 months after operation.Results All patients were followed up with an average of 15(12-18)months,postoperatively.Bone union was achieved in all patients,the healing rate was 100%.The average healing time was 8.5(5.5-14.5)months.All patients were confirmed by X-ray or CT examination.Subjective pain symptoms disappeared in all patients,and no obvious complications occurred.There were no incision infection and fatigue fracture of internal fixator in this group.No malunion was found in all patients,and limb function recovered well.Two patients remained slightly lame.Thevisual analogue score decreased from(6.0±1.1)before operation to(2.0±1.3)at the last follow-up after operation,and the difference was statistically significant(P<0.05).Conclusions Additional locking plate fixation together with decorticated bone grafting in treatment for femoral shaft aseptic nonunion subsequent to failed intramedullary nailing is effective and reliable.It is an effective method for treatment of femoral shaft aseptic nonunion.