四肢长骨骨折内固定术后非感染性骨不愈合临床治疗研究

目的探讨四肢长骨骨折内固定术后非感染性骨不愈合的治疗方法及疗效。方法自1996年1月～2006年12月行钢板或交锁髓内钉手术治疗四肢长骨骨折428例,有42例发生非感染性骨不愈合（9.81%）。行更换钢板或交锁髓内钉固定加骨移植手术33例,单纯行髓内钉动力化9例。结果所有病例均随访至骨愈合,平均随访25个月,再次行钢板或交锁髓内钉固定加植骨术后骨折愈合率100%,平均愈合时间（13.5±6.1）个月,单纯髓内钉动力化术后骨折愈合率77.8%,平均愈合时间（15.5±6.3）个月。结论再次内固定加植骨术是治疗非感染性骨不愈合的较好方法,单纯行髓内钉动力化仍有骨不愈合的可能。

The clinical study of non-infected nonunion of bone fracture after initial fixation

Objective] To assess the clinical effectiveness of different surgical options for the treatment of non- infection nonunion of long limb fracture after initial fixation. Methods] From January 1996 to December 2006, 428 patients were treated with plate or locked intramedullary nailing fixation for long limb fracture, non-infection nonunion occurred 42 eases （9.81%）. All of the 42 patients underwent revision operation. The methods were that exchanging for plate fixation or locked intramedullary nailing fixation combined with bone grafting in 33 cases, dynamization of the locking nail were performed in 9cases. Results] All of the patients were followed-up until the u- nion occurred （average, 25 months）. The healing percent of exchanging for plate fixation or locked intramedullary nailing fixation combined with bone grafting were 100%, average healing time were （13.5±6） months; and the healing percent of dynamization of the locking nail were 77.8%, average healing time were （15.5±6） months. Conclusion] The better way to the non-infection nonunion of long limb fracture is reoperation with initial fixation combined with bone grafting, only dynamization of the locking nail were not enough and it may be nonunion later.