尺桡骨骨折不愈合的相关因素及处理

Relative factors and treatment of the ununited fractures of the diaphysis of radius and ulna

目的探讨尺桡骨骨折不愈合的相关因素及处理方法。方法本组73例尺桡骨骨折不愈合患者分别选用不同的内固定、自体松质骨植骨、瘢痕、骨间膜松解以及局部皮瓣转移等综合治疗,术后尽早行前臂功能锻炼。结果随访12～29个月,73例均获骨性愈合,功能满意64例,优良率87.7%。结论影响尺桡骨骨折不愈合的主要因素包括局部软组织条件、骨折部位及损伤程度、内固定强度以及不恰当的早期活动等,感染不是主要因素。正确选择内固定方法、自体松质骨植骨、瘢痕组织及骨间膜松解是治疗尺桡骨骨折不愈合、恢复前臂功能的有效方法。

Objective To explore the possible causes and treatment of nonunion of fractures of diaphysis of radius and ulna. Methods According to different personal conditions and results of X gram, 73 cases of the nonunion fractures of diaphysis of radius and ulna were treated with different internal fixations, autologus spongy bone transplantation, release of scar and interosseous membrane, or local skin flap transposition. All had early functional mobilization of the forearm after operation. Results The patients were followed up for 12 to 29 months. All the cases had bony union, and 64 cases(87.7% ) obtained satisfactory functional rehabilitation. Conclusion The major causes that may lead to the nonunion of the diaphysis of radius and ulna are conditions of local soft tissue, site and severity of the fracture, security of internal fixation, and improper early movement, rather than infection. Proper internal fixation, autologus spongy bone transplantation, and release of scar and interosseous membrane are effective in treatment of the nonunion of the fracture and in the functional rehabilitation of the forearms.