四肢长骨骨折骨不连的原因和手术治疗

目的:探讨四肢长管状骨骨折术后骨不连的原因和再次手术疗效。方法:对2008年7月至2011年8月收治的27例四肢长管状骨骨折术后骨不连患者(肱骨9例,尺桡骨6例,股骨11例,胫骨9例)分析骨不连发生的原因,并再次行内固定术和自体髂骨取骨植骨术治疗。结果:引起四肢长管状骨骨折术后骨不连的原因有严重创伤、手术影响、骨折部位和患者全身情况等。经2～24个月(平均15个月)随访,所有患者于再次手术后均获骨性愈合。结论:四肢长管状骨骨折术后骨不连的发生原因是多方面的,病情重及医源性因素是导致术后骨不连的主要原因;再次手术时去除骨折端硬化骨,并开通髓腔以及坚强内固定和自体骨植骨可获得良好疗效。

Causes for the Nonunion of Bone Segments in Long Bone Fracture and Its Surgical Treatment

Objective: To explore the causes for nonunion of bone segment in long bone fracture of limbs after operation and the curative effect of the second operation.Methods: 27 cases of long bone fracture treated in our department from July 2008 to July 2011 were analysized for the causes of nonunion of bone segments after operation(9 cases in humerus,6 cases in feet,11 cases in radial femoral,9 cases in tibia),and the operation with inline fixation and autogenous iliac grafts were once more performed for the surgical treatment.Results: the results of analysis suggested that the causes for the nonunion of bone segments in long bone fracture after operatio involved serious trauma,influence of operation,fracture sites and the general health condition of patients,etc.With 2-24 months(15 months on the average) follow-up,all patients were found to get osseous healing after the second operation.Conclusion: There are various causes for f nonunion of bone segments after operation in long bone fracture,but seriousness of the illness and iatrogenic factors are the leading ones;Satisfactory effect can be achieved,with strong internal fixation and autogenous grafts,by removing hardened bone at the end of bone fracture and opening the medullary cavity in the second operation.