骨皮质剥脱术联合锁定接骨板治疗长骨骨不连

Decortication combined with locking plate fixation for the treatment of bone shaft nonunion in extremities

目的探讨骨皮质剥脱术联合锁定接骨板治疗长骨骨不连的临床疗效。方法2016年1月至2019年12月,我科采用骨皮质剥脱术联合锁定接骨板治疗长骨骨不连患者34例,通过术后每月复查患肢X线观察骨痂生长情况,比较术前和术后末次随访患肢卡氏评分(knee society score,KSS)、患肢关节活动度及日常生活能力(activity of daily living,ADL)指标进行研究。结果术后随访8~16个月,平均(10.2±3.3)个月,本组患者术后1个月摄片提示骨不连处可见骨痂;术后2个月见骨痂进一步浓集跨越骨折端,患肢可负重50%行走;术后4个月,骨折线模糊、连续性骨痂密集,骨折端无压痛,完全负重行走无疼痛,评估达到临床愈合标准。所有患者术后6~8个月均达到骨性愈合,术后伤口均Ⅰ期愈合,未出现感染等异常。末次随访,患者患肢KSS评分(91.90±3.24)分,ADL评分(79.70±9.40)分、关节活动度(148.9±18.5)°,术后各项随访指标结果均明显高于术前。结论骨皮质剥脱术联合锁定接骨板治疗长骨骨不连,临床效果显著,手术方法可靠,极大的改善患者愈后情况,值得推广。

Objective To explore the clinical effect and safety of decortication combined with locking plate fixation for the treatment of bone shaft nonunion in extremities.Methods Thirty-four patients with bone shaft nonunion in extremities were treated by decortication combined with locking plate fixation from January 2016 to December 2019.The effect was analyzed by observing the callus growth and comparing the preoperative and postoperative results of knee society score (KSS) and activity of daily living (ADL).Results All patients were followed up for (10.2±3.3) months (range:8-16 months).Bone callus appeared at the broken ends of the fracture 1 month after operation;the callus crossed the broken ends of the fracture and patients could walk with their 50% weight 2 months after operation;blurred fracture line,dense continuous callus,absence of tenderness and walking with 100% weight were observed 4 months after operation.Bone union was achieved in all the cases at 6-8 months after operation.Stage Ⅰ bone healing was shown without infection.KSS (91.90±3.24),ADL (79.70±9.40) and range of joint motion (148.9±18.5) ° at the last follow-up were significantly improved than that preoperatively.Conclusions Decortication combined with locking plate fixation is safe and effective in the treatment of bone shaft nonunion in extremities,which is worthy of clinical promotion.