骨外固定技术治疗复杂骨不连与骨缺损

目的：改进合并广泛软组织瘢痕，感染，骨缺损及肢体短缩骨不连的治疗。方法：总结1982－1999年采用骨外固定技术治疗112例骨不连的体会。所有骨不连均采用半环槽式外固定器行骨断端加压固定，对合并骨缺损及肢体短缩的部分病例，根据局部是否感染，感染静止与否，及肢体短缩的幅度，同期或二期行干骺端截骨延长术，在骨不连加压固定的同时或骨不连愈合后，重建肢体长度。结果：112例骨不连最终均达到骨性愈合。34例感染性骨不连伤口感染得到控制。非感染性骨不连骨愈合时间3－7个月，平均5．2个月；感染性骨不连骨愈合时间5－11个月，平均5．5个月。伴有肢体短缩的骨缺损，骨不连11例同期，8例二期重建了肢体长度，达到了肢体长度均衡。结论：采用骨外固定技术和治疗此类骨不连，由于在远离病灶的部位穿针固定，加上避开瘢痕组织显露骨不连断端，对骨不连断端的血循环及成骨潜力干扰小；不切除硬化骨质，亦不凿通髓腔及骨断端适当的修整，可在增加骨折固定稳定性的同时进一步避免肢体短缩；加压外尤其采用细钢针交叉穿放的弹性固定有利于骨折愈事；同期或二期行干骺端截骨延长有效的重建了肢体长度，达到了肢体长度均衡。

Treatment of complex bone nonunion with external skeletal fixation

OBJECTIVES: To summarize the experience in the treatment of 112 cases of complex bone nonunion from 1982 to 1999 in our department and introduce the technique of external skeletal fixation. METHODS: The two fragment ends of all cases were fixed under pressure with half-ring sulcated external skeletal fixator. Those cases complicated by bone defect or limb shortening were operated on with epiphysiotomy to restore the length of the limb in the period of compressive fixation or after the occurrence of bone union according to the condition of complicated infection and the length of the limb shortened. RESULTS: The nonunion of the 112 cases was united eventually. The infection in 34 cases was eradicated. Bone union in cases without infection took 3 approximately 7 months (average 5.2 months) and in cases with infection took 5 approximately 11 months (average 5.5 months). The length of the limb in 11 cases with bone defect was restored in the same period of compressive external fixation and another 8 cases achieved after bone union. The length between the injured and healthy limbs was balanced. CONCLUSIONS: When external skeletal fixation is employed to treat those troublesome cases of bone nonunion, the pins for fixation are inserted in sites far from the lesions and the non-united fragment ends are exposed only in the area without scars. Consequently, there is little interference with the blood circulation and the osteogenic potency of the fragment ends. The sclerotic bone tissue is not excised, the marrow cavity is not chased to be open and the fragment ends are only moderately modified. As a result, the stability of fixation is increased and further shortening of the limb avoided. External skeletal fixation using small pins with cross penetration results in plastic fixation and promotes bone healing. Bone lengthening with epiphysiotomy can restore the balance of the limbs.