扩髓带锁髓内钉治疗股骨、胫骨干骨折不愈合、延迟愈合

目的：总结使用扩髓带锁髓内钉治疗股骨、胫骨干骨骨折不愈合、延迟愈合的临床经验。方法：回顾自1999年4月2001年6月徼髓带锁髓内钉治疗股骨干、胫骨干骨折不愈合、延迟愈合病人21例，其中股骨8例，胫骨13例，钢板固定术后，股骨3例，胫骨6例。普通髓内针股骨5例。外固定架胫骨2例。石膏固定胫骨3例，骨牵引股骨2例。均采用有限切口切开复位顺行扩髓，静力锁定加植骨术。结果：随访半年以上18例，骨折均愈合，临近关节功能达正常。无感染、断钉等并发症。结论：采用有限切口切开复位、扩髓、静力锁定治疗股骨、胫骨干骨折不愈合、延迟愈合，具有骨折稳定性可靠、有利于骨折愈合和早期关节省魂优点，是治疗股骨、胫骨干骨折不愈合、延迟愈合的有效方法之一。     

带锁髓内钉治疗胫骨干骨折后骨延迟愈合及不愈合临床分析

目的总结带锁髓内钉治疗胫骨干骨折后延迟愈合和不愈合的临床病例,分析其产生的原因。方法回顾性分析2003年2月～2005年12月收治的72例新鲜胫骨干中下段骨折患者采用切开复位带锁髓内钉固定,对发生延迟愈合及不愈合病例进行总结,分析原因。结果胫骨中段骨折39例,其中延迟愈合6例,不愈合2例；胫骨下段骨折33例,延迟愈合7例,不愈合6例。结论胫骨干中下段骨折采用开放复位带锁髓内钉治疗虽可解剖复位,但对骨折端血循环破坏严重,是骨折延迟愈合与不愈合的主要因素。     

不扩髓带锁髓内钉治疗胫骨干骨折延迟愈合不愈合

<正> 胫骨干骨折不愈合是常见的骨折后期并发症,治疗方法有多种。1998年以来我院对24例胫骨骨折不愈合患者采用不扩髓带锁髓内钉治疗,术后随访11～24月,疗效满意。 1 资料与方法 1.1 一般资料:本组24例,男性16例,女性8例,年龄18～51岁,平均31岁。粉碎性多段骨折4例,不稳定骨折20例,     

中西医结合治疗胫骨骨折不愈合

我院自 1996年 10月～ 1999年 10月间 ,运用中西医结合治疗胫骨骨折不愈合 ,取得满意疗效 ,现总结报告如下。1　临床资料12 6例中男 10 0例 ,女 2 6例 ;年龄 2 1～ 5 4岁。骨折性质 :开放性 3 6例 ,闭合性 90例 ;骨折部位 :胫骨中段 3 7例 ,中下段 89例 ;骨折后行手术切开复位内固定 10 6例 ,行跟骨牵引12例 ,手法闭合复位后石膏或夹板外固定 8例。 12 6例病人骨折部位均有不同程度的肿痛、压痛、异常活动 ,患肢功能障碍。Ｘ线片示 :骨端硬化、髓腔封闭或骨端萎缩疏松 ,中间存在较大间隙 ;或两骨折端相互间形成杵臼状假关节 ,骨端硬化。2　…     

肥胖与四肢骨折愈合的相关性探讨

目的 探讨肥胖与四肢骨折愈合的相关性.方法 回顾分析自1994年8月～2006年8月收治的闭合性四肢长管状骨骨折患者1 218例,男性842例,女性376例;年龄6～75岁.按体重指数(BMI)情况分为2组,BMI＜25 kg/m2 824例,58例发生骨不连,76例发生骨延迟愈合;BMI≥25 kg/m2 394例,46例发生骨不连,57例发生骨延迟愈合.结果 BMI≥25 kg/m2者骨不连和骨延迟愈合发生率均明显高于BMI＜25 kg/m2(P＜0.01).结论 肥胖是引起骨折延迟愈合或不愈合的一个重要因素.     

外固定器加微创植骨治疗胫骨骨折不愈合、延迟愈合

目的：探讨运用外固定器加微创植骨治疗胫骨骨折不愈合、延迟愈合，观察其疗效。方法：运用外固定器行胫骨复位加压固定，对骨折不,连接处用磨钻磨除骨折端纤维及硬化骨质，行骨折端闭合植入微粒松质骨。结果：17例手术切口均一期愈合，全部病例经1年以上随访，骨折合部愈合，愈合时间在3个月－6个月。结论：骨外固定器加微创植骨，骨折固定牢稳，不破坏断端血运，有利于骨的修复，创伤小，是治疗胫骨骨折不愈合、延迟愈合的一种较好方法。     

交锁髓内钉治疗长管状骨骨折不愈合及延迟愈合

目的 通过32例长管状骨陈旧性骨折、骨折延迟愈合或不愈合病例治疗，探讨分析该组病例首次治疗失败的原因及再次手术的体会。方法 分析32例患者本次手术前的X线片、局部情况及手术中情况，推断导致骨折不愈合及延迟愈合的可能情况。并使用扩髓后交锁髓内钉治疗，早期以静力型交锁，3－6个月后改动力型交锁，9例患者同时行植骨术，术后辅以循序渐进的康复训练。结果 随访18－46个月，平均27．5个月。骨折愈合率至术后12个月达81．25％（26／32例），至术后27．5个月达96．88％（31／32），至术后43个月达100％。骨折愈合时间8．3－43个月，平均13．4个月，无严重并发症发生。结论 骨折早期正确处理与预后直接相关，交锁髓内钉是治疗长管骨骨折不愈合的较好选择。     

影响长管状骨骨折愈合机械因素的研究进展

骨折是机械性超负荷的结果,是骨的连续性的破坏。骨折形态主要取决于载荷及能量的释放的形式。骨折愈合是原始连续性的重建,是一个复杂的组织学修复过程,涉及一系列不同的细胞活动。Ｍｃｋｉｂｂｉｎ认为,骨折早期的原始骨痂反应是骨组织对损伤的最基本反应,可以肯定是损伤骨组19990715收稿,19991018修回作者单位:第二军医大学长海医院骨科,上海　200433作者简介:张雪松(1973),男,硕士,医师。研究方向:骨折愈合张春才(1948),男,教授,博士生导师,科副主任。研究方向:创伤织自身在局部引发这种反应。随后的骨痂桥接过程与机械力学因素关系密切…     

四肢长管状骨骨折延迟愈合21例分析

四肢长管状骨骨折利用中西医结合方法治疗大多数可获得满意疗效 ,但仍有少部分由于各种原因 ,出现骨折延迟愈合或不愈合。骨折的延迟愈合是一个可逆性病变期 ,探讨其原因对于促进其正常愈合避免其延迟愈合或不愈合有很重要的临床意义。本文就我院近 1 0年间收治的 2 1例长骨延迟愈合病例 ,就其原因教训及预防等方面进行分析讨论。临床资料2 1例中男性 1 7例 ,女性 4例 ,年龄在 1 8～ 54岁 ,平均 36.8岁。尺桡骨骨折 2例 ,肱骨骨折 3例 ,股骨干骨折 5例 ,胫腓骨骨折 1 1例。开放性骨折 5例 ,闭合性骨折 1 6例 ,合并桡神经损伤 1例 ,合并腓总…     

骨科教程胫骨延迟愈合

胫骨干骨折不愈合常见并可以引起伤残。可能需要多次手术治疗，从而延长了住院时间，并且在达到愈合或最终做截肢之前可以有多年的残疾。大多数胫骨骨折在初始治疗后能够愈合，但是所有治疗过胫骨骨折的医生都曾见到过胫骨骨折不愈合。能早期认识到不愈合的可能性，随之早期进行干预，将会缩短最终愈合的时间，也减少了医生和患者所受到的折磨。本期教程讲座将对胫骨骨折延迟愈合进行全面分析，并介绍可供选择的治疗方法来处理不同形式的临床难题。     

Monitoring and healing analysis of 100 tibial shaft fractures

BACKGROUND: We assessed the value of measuring biomechanical stiffness by assessing the fixator's external deformation as an objective means for monitoring fracture healing and determining the postoperative treatment regime, as compared to clinical and radiographic means of evaluation. PATIENTS AND METHODS: One hundred patients with tibial shaft fractures managed by unilateral external fixation had their fracture stiffness monitored. Stiffness was measured and clinical and radiological examinations were performed every 3-4 weeks. RESULTS: The time required for healing as indicated by stiffness measurement was an average of 2.5 weeks earlier than by radiological assessment. Eighty-two patients healed within 19 weeks (12.1+/-3.3 weeks) and ten patients in the following 6 weeks (24+/-4.3 weeks). Eight patients did not show an increase in fracture stiffness and received intramedullary nailing at a second operation. The average healing time was 11.3+/-4 weeks for type A, 13.1+/-3.6 weeks for type B fractures, and 15.1+/-5.9 weeks for type C fractures. The healing time for closed fractures was 11.3+/-3.2 weeks and for open fractures 14+/-4.9 weeks. CONCLUSIONS: The measurement of fracture stiffness allows the detection of patients at risk for nonunions. The healing time increased with increasing fracture gap size and was less in patients with younger age, less complex fractures, and lesser degrees of soft tissue damage.     

The difficult healing of segmental fractures of the tibial shaft

Summary Segmental fractures of the tibial shaft are always caused by a high-energy direct trauma. They are frequently associated with important soft tissue injuries, and the vascularization of the intermediate bone fragment is severely disturbed. The postoperative problems of 40 patients with 41 segmental tibial shaft fractures were reviewed. Twenty-three fractures (56.1%) were treated with a plate osteosynthesis, 18 (43.9%) with an external fixator. Thirty-seven fractures could be followed-up until bony consolidation. Bone-healing problems were seen in 29%, always in the distal fracture. A good functional result, could be obtained in 78.4%. The problems of each stabilization method are discussed. The vascularization of the intermediate segment may not be endangered secondarily by the stabilization procedure.

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Zusammenfassung Die Etagenfraktur des Tibiaschaftes entsteht immer nach einem hochenergetischen und direkten Trauma. Sehr oft sind schwere Begleitverletzungen der Weichteile vorhanden und die Durchblutung des intermediären Knochensegmentes ist schwer gestört. Die postoperativen Probleme von 40 Patienten mit 41 Etagenfrakturen des Tibiaschaftes wurden nachgesehen. 23 Frakturen (56,1%) wurden mit einer Plattenosteosynthese, 18 (43,9%) mit einer äußeren Fixation versorgt. 37 Frakturen konnten bis zur Knochenheilung nachverfolgt werden. Frakturheilungsstörungen wurden in 29% gesehen, immer in der distalen Fraktur. Ein gutes funktionelles Ergebnis konnte in 78,4% erreicht werden. Die spezifischen Probleme jeder Stabilisierungsmethode werden besprochen. Die Durchblutung des intermediären Knochensegmentes darf durch das Osteosyntheseverfahren sicherlich nicht gefährdet werden.

     

Open tibial shaft fractures: a comparative analysis of different methods of fixation in southwestern Greece.

A change in the method of managing open-grade-III tibial shaft fractures provided a new opportunity for a comparative study. One series of patients was treated exclusively by internal fixation and compared with another series treated with external fixation solely as well as with a series treated initially by external skeletal fixation and later by "Sarmiento walking plaster." The latter method was found to be a successful treatment and a good alternative to internal fixation for open grade-II and grade-III tibial shaft fractures when soft-tissue healing was completed. The supplementary use of the Sarmiento walking plaster had dramatically decreased the duration of hospital stay, saving the patient from an additional operation. There were no nonunions in this series. In open grade-I-II tibial shaft fractures, the deep infection rate in the cases in which internal fixation was used was significantly higher (5.4%), than that observed in the cases treated with external fixation, in which there was no deep infection. The nonunion rate was higher (22%) in the external fixation group compared with the internal fixation group (9%). The functional impairment of the ankle joint of the affected limb was less (15%) by using internal fixation than that of either the external fixation group (20%) or the group where the external fixation was changed to a Sarmiento walking plaster (35%).     

Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation

INTRODUCTION: Segmental fractures of the tibial shaft (AO type 42-C2) often occur after a high energy direct trauma with consecutive severe soft tissue injury and a high rate of open fractures. The blood supply of the intermediate bone fragment can be severely disturbed and therefore operative treatment is demanding. In this retrospective study, we compared three different methods of stabilisation. MATERIALS AND METHODS: We reviewed the clinical charts and postoperative problems of 26 patients in a ten year period. Sixteen (62%) fractures were stabilised with an intramedullary nail, five (19%) fractures by plate osteosynthesis and five (19%) fractures with an external fixator. RESULTS: Bony consolidation was obtained in all patients after an average time of 11.4 months. In 17 patients (65.4%) a second operative procedure had to be performed. Pseudarthrosis was seen in 11 fractures (40%), three times in the proximal and eight times in the distal fracture. In the intramedullary nailing group, pseudarthrosis occurred in nine patients. In the group treated with an external fixator, pseudarthrosis was seen three times. After changing to a different implant bony consolidation was achieved in every patient. CONCLUSION: Conventional intramedullary nailing is not suitable for stabilisation of segmental fracture types with a short metaphyseal fracture fragment. New nails with proximal and distal interlocking in three different planes offer better stability. Bone vascularisation should not be endangered by the stabilisation procedure and optimal reduction of the fracture is an important prerequisite for uneventful fracture healing, especially in this difficult fracture configuration.     

Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures

European Journal of Orthopaedic Surgery & Traumatology - The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the...     

The healing of closed tibial shaft fractures. The natural history of union with closed treatment

One hundred consecutive closed fractures of the adult tibial shaft treated by closed methods were surveyed prospectively in order to observe their natural history. The fractures were analysed with regards to speed of healing and the influence of age, sex, causal force, radiological morphology and concurrent fibular fracture. At 20 weeks 19 fractures had not yet united, but 15 of these had united by 30 weeks with conservative treatment alone. The remaining four cases were operated upon because no further progress in healing was anticipated. These findings suggest that, with regard to healing, open reduction and internal fixation is rarely justified in closed adult tibial shaft fractures.     

External fixation of tibial shaft fractures

Summary Over a 6-year period (1977–1983), 59 patients with 61 tibial shaft fractures were treated by external fixation. Of these patients, 42 with 42 fractures were followed up until solid union. Thirty-seven fractures were caused by high-energy impact, mainly road accidents. Seventeen fractures were closed and 25 were open. In 33 patients an external quadrilateral frame system was applied primarily, and in the remaining nine within 1–2 weeks. No predrilling was done, and in 16 patients nonthreaded connection rods were used throughout the period in the fixator. The process of union was monitored by repeated noninvasive measurements of stability. Average time from injury to dismantling of the external fixation was 5.2 months (range 2–12.5 months) and time-to-union for the whole series was 10.0 ± 5.5 months (range 4–31 months). Sixteen fractures failed to unite. Compared with other published series treated by external fixation, the incidence of non-union in the present series is high. On the basis of the present findings it is concluded that a compression device should be mounted either primarily or as soon as possible during the process of union, and that compression should be applied at regular intervals. If an external fixator is used, the surgeon must bear in mind the possible complications. It is probably safer to reduce rather than to prolong time-to-removal of the external fixation system.