附加锁定钢板并植骨治疗保留髓内钉的下肢长骨干骨折不愈合

Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail

目的:探讨保留原有髓内钉基础上附加锁定钢板并植骨治疗下肢长骨干骨折髓内钉固定术后不愈合的临床疗效。方法:回顾性分析2015年6月至2020年6月收治的20例下肢长骨干骨折髓内钉固定术后骨折不愈合患者,均采用保留原髓内钉,取自体髂骨植骨,行陈旧性骨折切开复位钢板内固定并植骨术,其中男14例,女6例;年龄35~56(42.2±9.6)岁;股骨干骨折9例,胫骨干骨折11例。根据骨折端不愈合的特点分型:稳定/萎缩型6例,不稳定/肥大型9例,不稳定/萎缩型5例。骨折不愈合时间为初次术后8~12(9.8±2.0)个月。记录并比较术前及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS),膝关节活动度,骨愈合时间及并发症和骨折端愈合情况。结果:所有患者获得随访,时间18~48(36.3±10.5)个月。所有患者术后切口Ⅰ期愈合,无感染及内固定断裂等并发症发生。骨折均达到骨性愈合,股骨愈合时间(8.5±2.6)个月,胫骨愈合时间(9.5±2.2)个月;膝关节活动度由术前的(101.05±8.98)°提高至末次随访(139.35±8.78)。(t=-12.845,P<0.001)。VAS由术前(5.15±1.72)分降至末次随访(0.75±0.96)分(t=11.186,P<0.001)。结论:在保留原有髓内钉基础上,附加锁定钢板内固定并取自体髂骨植骨术,具有操作简单、创伤小、并发症少及骨折愈合率高等优点,是治疗下肢长骨干骨折髓内钉固定术后骨不愈的有效手术方案之一。

Objective To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.Methods A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020.All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone,and were underwent open reduction plate internal fixation and bone grafting for old fractures.Among them,14 were males and 6 were females,aged from 35 to 56 years old with an average of(42.2±9.6) years old.Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture.According to characteristics of fracture end nonunion,6 patients were stable/atrophic,9 patients were unstable/large,and 5 patients were unstable/atrophic.The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery.Visual analogue scale(VAS),knee range of motion,bone healing time,complications and fracture-end healing were recorded before and at the latest follow-up.Results All patients were followed up for 18 to 48 months with an average of(36.3±10.5) months.The incision of all patients were healed at stage I without complications such as infection or internal fixation ruptur.Healing time of femur and tibia was(8.5±2.6) months and(9.5±2.2) months.Knee joint motion increased from preoperative(101.05±8.98) ° to postoperative(139.35±8.78) ° at the latest follow-up(t=-12.845,P<0.001).VAS decreased from preoperative(5.15±1.72) to postoperative(0.75±0.96) at the latest follow-up(t=11.186,P<0.001).Conclusion On the basis of retaining the original intramedullary nail,the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation,less trauma,fewer complications and high fracture healing rate.It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.