四肢长骨骨折骨不连的原因和手术治疗探讨

目的：研究分析四肢长骨骨折骨不连的原因和手术治疗效果。方法选取该院2012年4月—2013年5月间收治的50例四肢长骨骨折骨不连患者,对其骨不连的原因进行分析,并进行手术治疗,采取内固定和自体髂骨取骨植骨术治疗,观察手术治疗的效果。结果对所有患者均进行随访,随访时间为4~17个月,所有患者再次手术后伤口均一期愈合,骨折部位均骨性愈合,骨折愈合时间为5~10个月。术后随访复查X线片显示：所有患者在2个月左右骨折端有新的骨痂生成,3~4个月有连续骨痂生成,6~8个月骨折达到临床愈合。另外,所有患者手术治疗的平均时间为（32.58±15.69）min,在术中平均出血量为（22.14±5.67）mL。结论四肢长骨骨折骨不连的原因有多方面,其中伤情严重和医源性因素是造成骨不连的主要因素。通过使用手术去除硬化骨,并打通髓腔,加强固定和植骨手术治疗可以取得较好的效果。     

钢板固定联合自体髂骨植骨治疗股骨髓内钉失败骨不连的效果观察

目的观察钢板固定联合自体髂骨植骨治疗股骨髓内钉失败骨不连的临床效果。方法回顾性分析本院在2017年1月-2018年12月收治的股骨髓内钉失败术后骨不连患者20例,采取钢板联合自体髂骨植骨治疗的方法对骨折部位进行治疗,观察术后患者的X线片情况、骨折愈合时间以及疼痛评分和生活质量评分情况。结果 (1)X线片显示,术后患者骨折线模糊,有连续性骨痂通过骨折线,骨折部位局部无压痛或叩击痛;(2)术后骨折都在4-11个月内愈合,且骨折部位生长良好,未出现切口感染、下肢深静脉血栓等并发症;(3)术后患者疼痛评分低于术前,生活质量评分高于术前,差异具有统计学意义(P<0.05)。结论钢板固定联合自体髂骨植骨治疗股骨髓内钉失败骨不连临床疗效较好,安全可靠,值得在临床中推广和使用。     

Sequential technetium-99m/gallium-67 scintigraphic evaluation of subclinical osteomyelitis complicating fracture nonunion

Twenty-four patients with a history of post-traumatic fracture nonunion underwent sequential 99mTc and 67Ga citrate scintigraphy in an attempt to differentiate between posttraumatic fracture nonunion and nonunion complicated by subclinical osteomyelitis. Neither technetium nor gallium studies alone nor in combination, with or without clinical correlation, could help delineate between fracture nonunion and nonunion complicated by subclinical osteomyelitis because of the increased technetium and gallium radioisotope uptake associated with the nonunion site.     

肱骨外髁骨折骨不连并肘内翻畸形的手术治疗

目的 探讨肱骨外髁骨折并肘内翻畸形的矫正及内固定方法。方法 骨折复位髁上楔形截骨手术治疗。结果 平均随访8个月，骨不连及肘内翻同时得到矫正，本组5例，优4例，良1例，优良率100％。结论 该手术方法操作简单、确切有效，是一种较好的治疗方法。     

改进的体外冲击波技术对骨组织影响的实验及临床研究

采用改进的体外冲击波作用于骨组织。通过动物实验，骨膜组织体外培养Ｈ３－ＴｄＲ掺入放射性自显影研究，证实冲击后１、２周实验侧骨膜组织Ｈ３－ＴｄＲ标记率明显高于对照侧（Ｐ＜０．０５），表明实验侧骨膜成骨细胞有丝分裂明显加强，骨膜成骨作用增强。通过体外冲击波治疗骨不连１６例及骨折延迟愈合１６例。治疗后１６周，１６例骨折延迟愈合均愈合。１６例骨不连中１３例愈合。文中还对体外冲击波治疗疾病的作用机理、疗效及治疗方法等进行了探讨。     

股深血管及穿血管股骨膜（骨）瓣转位的应用解剖

目的：为股骨骨折、骨不连提供带血管蒂骨膜（骨）瓣转位修复的解剖学基础。方法：在４０侧成人下肢标本上，解剖观察了股深血管穿支的起始、走行、分支、吻合及骨膜支。结果：股深血管主干经大收肌和短收肌之间，贴股骨后内侧下降直达大收肌止端深面，沿途分出３～４支穿动脉，起始点距小转子尖下依次为４．５±１．３ｃｍ、９．３±２．６ｃｍ、１４．３±３．１ｃｍ和１６．０±１．５ｃｍ，外径分别为２．８±０．７ｍｍ、２．４±０．６ｍｍ、２．２±０．５ｍｍ和１．３±０．２ｍｍ。各穿支分出１～３支外径１．０ｍｍ左右的肌骨膜支，分布股骨体粗线及粗线两侧骨膜，形成骨膜动脉网。结论：以股深血管及其穿支为蒂可设计３种骨膜（骨）瓣修复股骨各段骨折骨不连。     

Plain film evaluation of bone grafting for nonunited scaphoid fractures

Objective To determine how the appearance of fracture line bridging and graft incorporation changed on sequential plain films obtained during the healing of successful grafts for scaphoid nonunion.Patients We identified 50 patients who had healed Russe bone grafts for nonunited scaphoid fractures. These patients had 214 sets of wrist radiographs obtained 1–36 months after surgery. Each set of radiographs was reviewed in random order by two observers who were blinded as to the patient's name and the time interval since surgery. Closure of the fracture line and the presence of a linear lucency in each of six zones surrounding the graft were assessed using a three-point grading scale.Forty-six men and four women were included in the study. Their mean age was 30 years with a range from 21–43 years.Results and Conclusions With increasing time after surgery, there was progressive fracture line closing and disappearance of linear lucencies at the interfaces between the scaphoid and the graft. However, 20% of the patients had a well-defined lucency in at least one of the six zones around the graft on their last film. Even 1 year after surgery, the fracture line showed no bridging on the radial side in 22% of patients and on the ulnar side in 11%. We conclude that after grafting, most scaphoid nonunions show progressive fracture line closure and graft incorporation. However, the fracture line may not completely close and lucencies may persist in several zones around the graft for more than 1 year. These radiographic appearances should be recognized as part of the normal spectrum of healing.     

36例长骨骨不连骨缺损的综合治疗

目的：探讨四肢长管状骨骨不连、骨缺损的治疗方法。方法：36例骨不连、骨缺损病人采用交锁髓内钉内固定，取自体髂骨植骨及术后经皮注射金葡液等综合治疗。结果：36例术后X线片显示，1个月骨折端周围出现骨痂，3个月有连续骨痂形成，6个月骨折愈合。无内固定物断裂、弯曲和松动，关节活动基本正常。结论：交锁髓内钉内固定、自体髂骨植骨及术后经皮注射金葡液综合治疗骨不连骨缺损，能提供坚强内固定，促进成骨活动，加快骨折愈合，是治疗长骨骨不连骨缺损的较好方法。     

带旋股外侧血管升支或横支骨瓣转移治疗股骨干中下段骨不愈合

目的:探讨应用带旋股外侧血管骨瓣治疗股骨干中下段骨不愈合的可行性。方法:经解剖学研究,设计了带旋股外侧血管升支或横支的骨瓣,以降支为蒂转移到股骨干中下段的手术方法。结果:l临床应用8例,经1年5个月～4年6个月随访,取得满意疗效。结论:带旋股外侧血管升支或横支骨瓣转移治疗股骨干中下段骨不愈合,有方便、易行和可靠的优点。     

交锁髓内钉断钉与骨不连的力学研究及临床意义

目的:分析交锁髓内钉断钉和骨不连的力学机理,探讨其临床意义和预防方法。方法:将静力外带锁髓内钉远端的圆形锁孔改为长形锁孔,近端改为尾翼状,在粉碎、横断、斜型骨折模型上测量髓钉与锁钉间的剪力和骨折断端间的压力并与静力固定比较。临床随访、分析86例股骨和胫骨骨折静力交锁钉固定的相关并发症。结果:静力固定必然产生髓钉与锁钉间的剪力,其大小约等于正压力;改良交锁钉消除了髓钉与锁钉间剪力对骨折端的应力遮挡;86例中,骨延迟愈合、骨不愈合和断钉分别为7例(8.14％)、3例(3.49％)、2例(2.34％)。结论:骨不连是应力遮挡和血供障碍的必然结果;钉-钉间剪力、骨不连又是造成断钉的重要原因。预防方法是使用动力交锁内固定。