鎖定鋼板聯(lián)合自體髂骨植骨治療四肢長骨干骨折術(shù)后無菌性骨不連的效果觀察

劉志軍

[摘要] 目的 研究評(píng)價(jià)鎖定鋼板聯(lián)合自體髂骨植骨治療四肢長骨干骨折術(shù)后無菌性骨不連的臨床效果。 方法 選取2006年1月～2013年6月因內(nèi)固定失敗而造成四肢長骨干無菌性骨不連患者43例，均采用鎖定鋼板固定聯(lián)合自體髂骨植骨進(jìn)行治療。 結(jié)果 患者均獲得隨訪，隨訪時(shí)間7～24個(gè)月，平均12.6個(gè)月。骨不連均愈合，愈合時(shí)間為（5.9±1.0）個(gè)月。3例（6.9%）出現(xiàn)切口表面感染，經(jīng)治療后均痊愈；2例（4.7%）切口延遲愈合；1例（2.3%）出現(xiàn)肢體短縮約2 cm，無一例發(fā)生骨折畸形愈合。末次隨訪時(shí)關(guān)節(jié)活動(dòng)度較術(shù)前顯著改善，其中功能優(yōu)良35例（81.4%），可7例（16.3.%），差1例（2.3%）。 結(jié)論 鎖定鋼板聯(lián)合自體髂骨植骨治療四肢長骨干骨折術(shù)后無菌性骨不連，具有確切的療效，鎖定鋼板聯(lián)合自體髂骨移植治療能為骨折提供可靠的內(nèi)固定穩(wěn)定性和良好的骨誘導(dǎo)以及骨傳導(dǎo)作用，效果良好。

[關(guān)鍵詞] 鎖定鋼板；四肢長骨干骨折；骨折固定術(shù)；內(nèi)固定器；髂骨移植

[中圖分類號(hào)] R683.4 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1674-4721（2014）08（a）-0176-04

Effect observation on locking plate combining with autologous iliac bone graft in the treatment of aseptic nonunion after surgery of long bone fractures of extremities

LIU Zhi-jun

Department of Orthopedics，Shengbei Hospital，Shengli Petroleum Administration of Dongying City in Shandong Province，Dongying 257064，China

[Abstract] Objective To research and evaluate the effect of locking plate combining with autologous iliac bone graft on treating aseptic nonunion after surgery of long bone fractures of extremities. Methods 43 cases of patients with aseptic nonunion on limb long bone caused by bone fixation failure were accepted in our hospital from January 2006 to June 2013.All of patients were treated with locking plate combining with autologous iliac bone graft. Results All patients were followed up.The follow-up time ranged from 7 to 24 months，with an average of 12.6 months.All of nonunion were healed in （5.9±1.0） months.Cut surface infection occurred in 3 cases （6.9%），which were cured after treatment.The slowly healed wound were 2 cases （4.7%） and limb about 2 cm shortened in 1 case （2.3%）.None of cases suffered from malunion.At the final follow-up，joint activity improved more significantly compared with before surgery，including 35 cases （81.4%） with excellent effect，7 cases （16.3%） moderate，and 1 case （2.3%） poor. Conclusion In the treatment of patients with aseptic nonunion after surgery of long bone fractures of extremities，using locking plate for internal fixation is a curative therapy.Locking plate combining with autologous iliac bone graft can provide reliable fixation stability for fractura，and shows good functions on bone induction and conduction，so it obtains a favorable effect.

[Key words] Locking plate；Limb long bone fracture；Fracture fixation；Internal fixation；Iliac bone graft

四肢長骨干骨折發(fā)生率較高，是臨床中常見的骨折，目前已經(jīng)普遍應(yīng)用各種內(nèi)固定材料進(jìn)行治療。大多數(shù)骨折在預(yù)期時(shí)間內(nèi)能夠愈合，而少數(shù)骨折因?yàn)樾g(shù)后感染、螺釘斷裂、鋼板斷裂、髓內(nèi)釘斷裂、內(nèi)固定材料變形等原因而在預(yù)期時(shí)間內(nèi)仍不能愈合而導(dǎo)致骨不連[1-3]。無菌性骨不連是四肢骨折治療過程中比較常見而又比較嚴(yán)重的并發(fā)癥之一[4]。因此，骨不連的治療被認(rèn)為是骨折處理中最大的挑戰(zhàn)之一[5]。骨不連的患者一旦確診，應(yīng)該盡可能快地進(jìn)行再次手術(shù)治療。通過更換內(nèi)固定材料，如更換髓內(nèi)釘或者鋼板，或者選用其他適宜的內(nèi)固定材料治療而獲得骨愈合的成功率在40%～100%[4，6-9]。本研究采用鎖定加壓鋼板治療因內(nèi)固定失敗而造成的無菌性骨不連43例，探討其臨床療效。endprint