锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连

目的 探讨锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连的手术技巧与临床疗效. 方法 回顾性分析2006年3月至2008年6月收治且获得随访的26例肱骨干骨折术后骨不连患者资料,男19例,女7例;平均年龄为46 7岁(19 ～63岁).骨不连类型:肥大型17例,萎缩型7例,假关节型2例.患者本次手术与上次手术的时间间隔平均为9.3个月(9.1～9.6个月).22例内固定治疗的患者行原内固定物取出、切开复位、自体髂骨植骨锁定加压接骨板内固定术,4例带外固定支架患者先去除外固定支架,行石膏固定1个月后再行切开复位、自体髂骨植骨锁定加压接骨板内固定术.术后肩关节及肘关节功能评估分别采用Constant肩关节评分和Mayo肘关节评分.结果 26例患者术后获平均25.6个月(25～33个月)随访.25例患者术后骨折获愈合,平均愈合时间为5 2个月(4 ～9个月);1例因术后伤口感染致骨折不愈合,经抗感染治疗5个月后骨折获愈合.2例发生桡神经不全损伤.Constant肩关节评分平均为(79.1±0.1)分,Mayo肘关节评分平均为(85 7±0 8)分.结论 锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连的关键是尽量彻底清理骨折断端、加压、充分有效的自体髂骨植骨.该方法可以极大地提高骨折愈合率,减少并发症的发生,且能获得较好的肩、肘功能.     

锁定加压钢板内固定结合自体髂骨植骨治疗肱骨干骨折术后无菌性骨不连

目的探讨锁定加压钢板(LCP)内固定结合自体髂骨植骨治疗肱骨干骨折术后无菌性骨不连的疗效。方法应用LCP内固定结合自体髂骨植骨治疗45例肱骨干骨折术后无菌性骨不连。结果本组获随访7～38个月,骨不连均获治愈。肩关节功能优良率91.1%,肘关节功能优良率100%。结论 LCP内固定结合自体髂骨植骨可以显著提高骨愈合率,是治疗肱骨干骨折术后无菌性骨不连的有效方法之一。     

自体髂骨改良结构植骨治疗四肢骨不连

目的 探讨自体髂骨改良结构植骨治疗四肢骨不连的临床疗效. 方法 回顾性分析2010年5月至2011年5月收治的60例四肢骨不连患者资料,男45例,女15例;年龄13～68岁,平均39.2岁.骨不连部位:肱骨干7例,胫腓骨19例,股骨干27例,桡骨远端4例,锁骨3例.骨不连按照Weber分型:肥大型3例,萎缩型15例,缺血型37例,假关节型5例.骨不连病程:6～25个月,平均12.5个月.入院前手术次数:1次42例,2次17例,3次1例.入院前固定方式:钢板固定45例,髓内钉固定8例,外固定支架固定7例.术中均采用自体髂骨改良结构植骨,并应用锁定钢板桥接内固定.术后随访患者,记录患者骨愈合时间及并发症发生情况等. 结果 60例患者术后获6 ～ 24个月(平均12.8个月)随访.59例骨不连患者于术后4～8个月(平均5.3个月)获愈合;1例股骨干骨不连患者术后6个月出现钢板断裂,入院再次行植骨,并在植骨区附加1块重建钢板加强固定,6个月后完全愈合.所有患者均无感染、畸形、双下肢不等长、取骨区疼痛等并发症发生. 结论 自体髂骨改良结构植骨能够最大程度地发挥植骨块的成骨效应,使植骨块迅速成活,从而达到治愈四肢骨不连的目的.     

胫骨骨折术后骨不连治疗方法的疗效比较

[目的]探讨带锁髓内钉固定后胫骨骨折骨不连治疗方法的选择和疗效。[方法]348例带锁髓内钉固定胫骨骨折中发生骨不连36例。采用冲击波治疗lO例；髓内钉动力化8例；髓内钉动力化加自体植骨6例；单纯自体植骨5例；改钢板固定加自体植骨3例；肥大型骨不连更换髓内钉4例。[结果]所有病例平均随访28个月。6个月内再手术者较6个月后再手术者愈合时间明显缩短（P〈0.05）。冲击波治疗10例中1例不愈合，经2次冲击波治疗后愈合。髓内钉动力化8例中2例不愈合，经冲击波治疗后愈合，其中2例发生骨缩短；髓内钉动力化加自体植骨6例均愈合；单纯自体植骨5例中2例8个月未愈合，更换髓内钉加自体植骨后愈合；改钢板固定加自体植骨3例均愈合；肥大型骨不连更换髓内钉4例均愈合。【结论】早期治疗带锁髓内钉固定后胫骨骨折骨不连效果肯定。髓内钉动力化可促进骨愈合，但有引起骨缩短的可能；更换髓内钉或钢板加自体植骨治疗骨不连效果满意；冲击波有促进骨不连愈合的作用。     

带锁髓内钉加自体髂骨植骨治疗胫骨骨不连的体会

目的探讨对5例胫骨骨折骨不连应用带锁髓内钉加自体髂骨植骨治疗,观察其疗效。方法5例胫骨骨不连的患者全部采用带锁髓内钉加自体髂骨植骨。结果5例患者经随访12～36个月,平均15个月,骨折均在4—8个月骨性愈合,功能恢复良好,无感染及断钉现象发生。结论带锁髓内钉加自体髂骨植骨治疗胫骨骨不连是一种治疗胫骨骨不连的有效方法。     

AO非扩髓肱骨交锁髓内钉在肱骨干骨折不愈合中的应用

目的 探讨AO非扩髓(AO—UHN)肱骨交锁髓内钉加自体松质骨植骨在肱骨干骨折不愈合中的应用。方法 20例患者手术取出原内固定，行正向或逆向插入AO—UHN肱骨交锁髓内钉，在不愈合部位行丰富的自体松质骨植骨。术后进行影像学观察和疗效评定。结果 20例患者有15例得到随访，随访时间为9～23个月(平均13．8个月)，愈合时间4～10个月(平均6．2个月)。除1例在12个月时仍未愈合予再次植骨后6个月获得愈合外，其余均在一次手术后获得愈合，优良率为90％。结论 AO—UHN肱骨交锁髓内钉加自体松质骨植骨是治疗肱骨干骨折不愈合的一种有效方法。     

重组合异种骨植骨治疗四肢长骨骨不连的疗效观察

目的 探讨重组合异种骨与自体髂骨两种不同植骨材料植骨治疗四肢长骨骨不连的临床疗效.方法 对255例1992年以来四肢长骨骨不连进行回顾性分析,其中男182例,女73例:6～75岁,平均34.9岁.骨不连部位:肱骨骨不连51例(男36例,女15例),尺、桡骨骨不连57例(男36例,女21例),其中尺桡骨同时骨不连10例,股骨骨不连67例(男43例,女24例),胫骨骨不连80例(男67例,女13例).所有患者均行切开复位,并内固定或外固定.植骨来源:自体髂骨植骨88例,重组合异种骨(recombinant bone xenograft,RBX)植骨69例,自体髂骨联合RBX植骨74例,其他材料或不植骨22例.结果 255例患者中12例失访.243例随访10个月～12年,平均4年6个月.总愈合率95.1%,自体髂骨组愈合率95.5%,RBX植骨组愈合率97.1%,自体髂骨联合RBX植骨组愈合率93.2%.各组之间差异无统计学意义(P＞0.05).结论 RBX与自体髂骨植骨治疗四肢长骨干骨不连,其愈合率差异无统计学意义.RBX植骨治疗骨不连,安全、生物相容性好,对促进骨愈合疗效可靠.     

带锁髓内钉加自体髂骨植骨治疗胫骨骨不连3例

目的探讨胫骨骨折骨不连的治疗方法。方法3例胫骨骨不连病人,全部采用带锁髓内钉加自体髂骨植骨。结果3例病人经随访12~36个月,平均15个月,骨折均在4~10个月骨性愈合,功能恢复良好,无感染及断钉现象发生。结论本组病例采用带锁髓内钉治疗,固定坚强,自体髂骨植骨,植骨可补充骨的基质,自体松质骨成活率高,有促进骨折愈合的作用。     

加压交锁髓内钉固定加植骨治疗胫骨骨不连的临床研究

目的:探讨加压交锁髓内钉内固定加交锁髓内钉开口处取骨植骨治疗胫骨骨不连的临床疗效。方法:回顾性分析自2008年2月至2010年10月采用加压交锁髓内定内固定加髓内针开口处取骨植骨治疗18例胫骨骨干骨不连,男12例,女6例;年龄31～67岁,平均42岁。受伤至手术时间6～18个月,平均8个月。骨折不愈合11例,延迟愈合7例。术后根据HSS评分系统评价膝功能,采用Tenny和Wiss评分系统评估疗效。结果:术后随访12～36个月,平均18个月,患者切口愈合良好,无感染,无皮肤坏死。全部患者未见骨不愈合、感染、畸形及再骨折发生。骨性愈合时间4～8个月,平均6个月。患者术后1年膝关节功能HSS评分平均(89.97±3.21)分。术后根据Tenny和Wiss评分系统评估疗效,优16例,良2例。结论:采用加压交锁髓内钉内固定加交锁髓内钉开口处取骨植骨治疗胫骨骨折不愈合及延迟愈合,能提高骨折愈合率,避免髂骨取骨带来的并发症,减少患者医疗费用。     

四肢非感染性管状骨术后骨不连的再次手术治疗体会

目的 探讨四肢非感染性管状骨内固定术后骨不连再次手术治疗的疗效. 方法 对2009年7月至2011年10月收治的57例四肢非感染性管状骨术后骨不连患者的临床资料进行回顾性研究,男43例,女14例;年龄16 ～ 70岁,平均41.5岁;骨不连类型:肥大性23例,萎缩性34例.骨不连病程9 ～ 72个月,平均16.4个月.采用单纯更换髓内钉治疗18例,更换钢板加植骨治疗24例,单纯自体髂骨植骨治疗15例.结果 所有患者术后获6 ～ 22个月(平均12.8个月)随访.其中56例患者获得骨折愈合,愈合时间5 ～ 16个月,平均8.8个月.1例植骨治疗后8个月钢板发生断裂,经再次植骨及更换内固定治疗,11个月后骨折获愈合. 结论 根据患者的具体情况选择个体化的手术方式,同时辅以正确的术后康复指导,四肢管状骨骨不连再次手术可以取得较好的疗效.     

肱骨骨不连的手术治疗

目的探讨肱骨骨不连的手术治疗方法及疗效。方法1998年12月～2005年5月共收治肱骨骨不连患者25例,均为肱骨骨折内固定术后发生骨不连,其中3例并发骨髓炎,6例合并不同程度肱骨骨缺损,骨缺损长度为3～6cm。骨不连病程8个月～5年。15例行吻合血管游离腓骨移植,10例采用加压交锁髓内针进行肱骨固定并辅以自体骨植骨。结果术后25例均得到随访,时间6个月～6年2个月。吻合血管游离腓骨移植组中移植的腓骨段均与肱骨干形成骨性愈合,平均骨性愈合时间为3．1个月；交锁髓内针组平均骨愈合时间为3．8个月。按Crates和Whittle肩肘关节功能评价标准,腓骨移植组：优9例,良4例,差2例；交锁髓内针组：优5例,良3例,差2例。结论应用加压交锁髓内针辅以自体骨移植对硬化性肱骨骨不连是一种有效的外科治疗方法；对合并骨髓炎、大段骨缺损及严重骨质疏松的肱骨骨不连,采用吻合血管游离腓骨移植可一期进行修复与重建。     

附加锁定加压钢板固定联合植骨治疗股骨转子下无菌性骨不连的疗效分析

目的:探讨附加锁定加压钢板联合植骨治疗股骨转子下无菌性骨不连的疗效。方法:回顾性分析2016年10月至2019年10月期间上海交通大学附属第六人民医院骨科收治的32例股骨转子下骨折髓内钉固定术后无菌性骨不连患者资料。男25例,女7例;年龄为27~68岁,平均50.5岁;骨不连时间为9~24个月,平均12.2个月。骨不连...     

Treatment of humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting

Twenty seven patients with humeral diaphyseal nonunion treated with interlocked nailing and autogenous bone grafting were retrospectively assessed. The mean age was 37 years (28 to 59 years). There were 16 women and 11 men. An average of 11 months (8 to 36 months) had elapsed between the initial trauma or treatment and presentation in our clinic. The nonunion site was in the distal third of the humerus in 18 patients (66%) and in the middle third in 9 (34%). Seventeen (73%) had hypertrophic and 10 (37%) atrophic nonunion. Patients were treated with locked intramedullary nailing and autogenous cancellous bone grafting. The mean follow-up was 42 months (28 to 62 months), and the mean time to union was 4.8 months (2.5 to 11 months). Three patients developed superficial infection. Union was achieved in all cases but one, in which there was multiple nerve injury. According to Steward and Hundley's scoring, results were good in 24 patients, fair in 2, and poor in one. Interlocked nailing and autologous bone grafting has a good rate of union provided nails of appropriate diameter are used and distal and proximal locking is performed correctly. We think that its low rate of infection, low risk of injury to the radial nerve, and low requirement for soft tissue dissection make it a suitable choice in the treatment of nonunions of the humeral diaphysis.     

肱骨交锁髓内钉治疗肱骨骨折术后骨不连

目的介绍应用肱骨交锁髓内钉治疗肱骨骨折术后骨不连的经验。方法1997年10月～2001年7月,应用肱骨交锁髓内钉治疗12例肱骨骨折术后骨不连患者,其中肥大型5例,萎缩型2例,假关节形成5例。受伤至骨不连手术的时间平均为10．5个月(5～33个月)。手术采用开放复位顺行置入髓内钉,锁入远端交锁钉后向近端打拔以使断端加压,自体髂骨及RBX植骨。结果所有患者获平均21个月(9～51个月)随访。12例患者骨不连均获得愈合,平均愈合时间为5．8个月(3．5～8．0个月)。其中1例去除髓内钉后1年于原骨不连部位发生再骨折,重新植骨内固定而获得愈合。11例肩关节及上肢功能恢复良好。所有患者未遗留神经损伤症状。结论肱骨交锁髓内钉为治疗肱骨骨折术后骨不连的有效方法。     

Ilizarov��s method for treatment of nonunion of diaphyseal fractures of the humerus

Background:

Nonunion in diaphyseal fractures of the humerus can be treated by various modalities like plating and bone grafting, exchange nailing, fibular strut grafting and Ilizarov’s method of ring fixation. To achieve union in infected nonunion in which multiple surgeries have already been done is further challenging. We conducted a prospective study wherein the outcome of the treatment of nonunion of diaphyseal fractures of the humerus by Ilizarov’s method was analyzed.

Materials and Methods:

Nineteen patients with diaphyseal nonunion of the humerus were treated by Ilizarov’s external fixator. These included nonunion after plating (n=11), intramedullary nailing (n=1) or conservative methods (n=7). In post-surgical infected nonunion (n=6), the implants were removed, debridement done, bone fragments were docked followed by application of ring fixator and compression. In aseptic nonunion (n=13), distraction for three weeks followed by compression was the protocol. Early shoulder and elbow physiotherapy was instituted. The apparatus was removed after clinical and radiological union and the results were assessed for bone healing and functional status.

Results:

Fracture union was achieved in all the 19 cases. Pin site infection was seen in 2 cases (10.52%). The bone healing results were excellent in eighteen cases (94.73%) and good in one case (5.26%).The functional results were found to be excellent in fourteen cases (73.68%), good in four (21.05%) and fair in one case (5.26%).

Conclusion:

Ilizarov’s method is an excellent option for treatment of septic and aseptic non union of diaphyseal fractures of the humerus as it addresses all the problems associated with non union of the humerus like infection, deformity and joint stiffness.     

锁定钢板内固定联合植骨治疗股骨骨不连或伴骨缺损

目的 探讨锁定钢板内固定联合植骨治疗股骨骨不连或伴骨缺损的疗效。方法 2005年6月至2010年6月应用锁定钢板治疗80例股骨骨折术后骨不连或伴骨缺损的患者,男60例,女20例;年龄8～68岁,平均38.2岁。骨不连部位：股骨近端16例,股骨远端40例,股骨干24例。骨不连原因：内固定失效60例,外固定失败5例,感染15例。骨不连病理分型：非感染性骨不连65例,其中肥大型15例,营养不良型10例,萎缩型40例（其中20例伴有骨缺损）;感染性骨不连15例。骨不连病程6～150个月,平均16.5个月。58例患者使用微创内固定系统钢板固定,22例患者使用锁定加压钢板固定。所有患者均进行植骨,其中自体髂骨移植35例,局部滑行加骨痂植骨10例,自体植骨结合同种异体松质骨移植8例,同种异体松质骨结合人工骨移植7例,吻合血管游离腓骨移植20例。结果 所有患者术后获6 ～ 36个月（平均13.8个月）随访。骨不连均在4～8个月（平均5.3个月）牢固愈合。无切口感染、内置物断裂及松动等并发症发生。16例股骨近端骨不连患者采用Sanders 创伤后髋关节评分标准评定疗效：优10例,良5例,差1例,优良率为93.8％。40例股骨远端骨不连患者采用美国膝关节协会评分系统( KSS)评定疗效：优25例,良12例,差3例,优良率为92.5％。24例股骨干骨不连患者采用Sanders创伤后髋关节评分标准和KSS评定疗效：优21例,良2例,差1例,优良率为95.8％。结论 锁定钢板内固定辅以植骨能明显促进骨愈合,是治疗股骨骨不连或伴骨缺损的有效方法之。     

Treatment of aseptic nonunion after intramedullary nailing fixation with locking plate

Objective: To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. Methods: Thirty‐eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non‐union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9–70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. Results: All patients were followed up for 6–20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4–8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow‐up. Conclusion: Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion.     

Treatment of nonunions of humeral fractures with inter-locking intramedullary nailing

Objective： To introduce the experience of treating nonunions of humeral fractures with interlocking intramedullary nailing.
Methods： Twelve patients with humeral nonunions were treated with interlocking intramedullary nailing. The time interval between trauma and surgery was 10.5 months on average. Open reduction with anterograde approach was performed. Axial compression was specially applied to the fracture site with humeral nail holder after insertion of distal locked screws. Iliac bone grafting was added.
Results： The average follow-up period was 21 months （ranging 9-51 months）. All patients achieved osseous union 5.8 months after treatment on average. Eleven patients hadgood functions of the shoulder joints and the upper extremities. No patient experienced any permanent neurological deficit. Refracture of the original ununited region occurred in one patient after removal of the internal fixator one year later, but union was achieved after closed re-intramedullary nailing fixation.
Conclusion： Humeral interlocking intramedullary nailing is an effective alternative treatment for humeral nonunion.     

带蒂骨痂植骨交锁髓内钉内固定治疗胫骨硬化型骨不连

[目的]观察交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗胫骨硬化型骨不连的临床疗效.[方法]本组胫骨硬化型骨不连12例,男8例,女4例;年龄26～64岁,平均45岁,全部采用开放置入交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗.[结果]经12～72个月,平均48个月的随访,所有病例均于4～6个月内获得骨性愈合.[结论]交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗胫骨硬化型骨不连具有：（1）合理的生物力学设计;（2）抗骨折旋转及短缩功能;（3）对局部血运破坏小;（4）带蒂骨痂植骨的＂架桥＂作用和自体髂骨植骨的成骨作用促进骨愈合,值得推荐使用.