附加钢板治疗下肢髓内钉固定后肥大性骨不连的疗效观察

目的探讨附加钢板加植骨术治疗股骨胫骨髓内钉固定后肥大性骨不连的方法及临床疗效。方法2005年9月～2007年9月,采用附加钢板加植骨术治疗股骨、胫骨干骨折交锁髓内钉内固定后出现肥大性骨不连的病例16例,从受伤到交锁髓内钉固定术后骨不连时间平均为8个月。钢板放于骨干旁侧偏前或偏后,骨折两端各用2～4枚螺钉固定,骨折间隙较大的行自体髂骨植骨,对骨折间隙较小的,采用同种异体骨。结果16例患者均在术后平均为14周(12～34周)X线显示开始有连续性骨痂通过,22～54周(平均为30.6周)出现骨性愈合。均无伤口感染,无内固定物断裂及松动等并发症,邻近关节功能恢复良好。结论采用附加钢板加植骨术改善骨折端局部不稳定,是治疗股骨、胫骨干骨折交锁髓内钉内固定后出现肥大性骨不连有效的方法。

Augmentative plate fixation with bone graft to treat hypertrophic nonunions of femur or tibia subsequent to intramedullary fixation

Objective To explore the effect of augmentative plate fixation with bone graft to increase stability in treatment hypertrophic nonunions of femur or tibia subsequent to intramedullary fixation.Methods 16 cases of hypertrophic nonunions of femur or tibia subsequent to intramedullary fixation with ugmentative plate fixation with bone graft from September 2005 to September 2007 were treated.The delayed time from injury to surgery for nonunion averaged 8 months.A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of the bone shaft.For those frictions with large gaps,autoilium bone graft was applied,while as for those frictions with narrow gaps homograft bone was applied.Results All the X-rays of the cases of patients have shown the existence of contineous callus after 14 weeks' operation.All the cases have obtained union within 30.6 weeks(range,22 to 54 months).No infection,hardware loosening or breaking was found.The fuctions of neighborhood joint have recovered smoothly.Conclusion Judging from the cases mentioned above,the augmentative plate fixation can be applied at the fracture site to prevent the rotational instability which is considered to be a cause of hypertrophic nonunion.The augmentative plate fixation with bone graft is effective for hypertrophic nonunions of femur or tibia subsequent to intramedullary fixation.