张-压应力刺激治疗四肢长骨萎缩性骨不连

Tension-compression stress stimulation by external fixation frame for atrophic nonunion of long bones in extremities

[目的]介绍通过外固定支架对骨折断端行张-压应力刺激治疗萎缩性骨不连的手术技术与初步临床结果。[方法]2014年6月—2018年4月采用张-压应力刺激治疗萎缩性骨不连13例。采用微创手术取出内固定物,但不处理骨折端,安装或调整原有外固定架。通过外固定支架施加张应力,而后压应力周期性刺激骨断端,1 mm/d,分4次完成。[结果] 11例通过一次张-压应力刺激后骨折愈合,1例骨段滑移断端不愈合通过两次张-压应力刺激后骨折愈合,1例合并肢体短缩,在骨不连愈合后行骨端截骨肢体延长纠正肢体短缩。骨不连愈合时间6.50~13.70个月,平均(10.06±2.04)个月。外固定支架佩戴时间为8.30~15.60个月,平均(12.91±2.29)个月。采用Paley骨不连评价标准评价疗效,优6例,良4例,可3例,优良率76.92%。[结论]萎缩性骨不连断端间纤维骨痂有成骨潜能,通过张-压应力刺激能有效激发纤维骨痂的成骨活性。

[Objective] To introduce the surgical technique and preliminary clinical results of tension-compression stress stimulation by external fixation frame for atrophic nonunion of long bones in extremities. [Method] From June 2014 to April 2018, 13 patients received tension-compression stress stimulation by the external fixation frame for atrophic nonunion of extremity long bones. Minimally invasive surgery was conducted to remove the internal fixation without treating the fractured ends, and then the external fixator was set up or adjusted.Tensile stress was applied, followed by the compressive stress periodically by using the external fixation frame to stimulate the fractured bone ends by 1 mm/day in 4 times. [Results] Of them,11 patients got fracture healed after one cycle of tension-compressive stress stimulation, 1 patient had nonunion of the transported bone segment was healed after 2 cycles of tension-compressive stress stimulations, and the remaining 1 patient who suffered nonunion combined with limb shortening, got the bone healed and limb shortening corrected after osteotomy and one cycle of tension-compressive stress stimulation. The healing time of nonunion was 6.50 to 13.70 months, with an average of(10.06±2.04) months, while external fixator bearing time lasted for 8.30 to 15.60 months, with an average of(12.91±2.29) months. Based on Paley’s criteria for nonunion outcome evaluation, the clinical consequences were marked as excellent in 6 cases, good in 4 cases and fair in3 cases, with the excellent and good rate of 76.92%. [Conclusion] The fibrous callus between the bone ends of atrophic nonunion has osteogenic potential, and can be effectively stimulated by tensile-compressive stress stimulation.