胫骨骨折骨不连的临床分析

目的：探讨胫骨骨折后骨不连的发生原因和临床各种不同的固定及植骨方法的治疗效果。方法：对近6年来收治的48例胫骨骨折骨不连病例临床资料进行回顾性分析。固定方式：加压钢板内固定23例，交锁髓内钉固定8例，外固定支架固定17例。植骨来源：自体髂骨植骨25例，同种异体骨植骨11例，混合植骨12例。结果：本组患者骨不连的原因分别为局部血供差，应力干扰，骨折复位不良，感染和骨缺损。48例患者全部获得随访，平均随访时间9个月（6～24个月），均获得骨性愈合，骨折愈合时间平均6．5个月（4～16个月）。其中42例患者（87．5％）下肢功能优良，无跛行等后遗症；6例患者（12．5％）遗留有跛行，邻近关节活动受限，肢体短缩等后遗症。结论：胫骨骨折后骨不连接的原因很多，如果在初始治疗胫骨骨折采用正确有效的治疗方法，多数骨不连是可以避免的。治疗胫骨骨不连的方法仍以手术治疗为主，采用有效坚强的固定加植骨能够获得良好的疗效。

The Clinical Analysis of Nonunion of Tibia Fractures

Objective:To explore the causes of nonunion of tibia fractures and the clinic effects of different fixators and bone grafts in treatment of nonunion of tibia fractures.Methods:The clinic data of 48 cases of nonunion of tibia fractures during the recent 6 years,were analyzed retrospectively.Different fixations were applied for the patients:dynamic compression plates(DCP)in 23 cases,interlocking medullary nails in 8 cases,external fixators in 17 cases.For bone graft,autogenous ilium in 25 cases,allograft-bone in 11 cases,autogenous ilium plus allograft-bone in 12 cases.Results:The main causes for nonunion in this series were found to be poor local blood supply,stress interference,poor reduction,infection and bone defects.Forty-eight patients were available for follow-ups.The mean time of follow-up was 9 months(range,6 to 24 months).Bony union was achieved in all the patients after a mean of 6.5 months(range,4 to 16 months).Functional results were excellent in 42 patients(87.5%).Six(12.5%)patients had such complications as stiffness of neighboring joints,lameness and limb shortening.Conclusion:Nonunion of tibia fractures usually results from multiple causes.In most cases,nonunion could be avoided if effective measures could be taken in the initial treatment of tibia fractures.Successful treatment of nonunion of tibia fractures often requires surgical actions,good outcome can be expected after operative fixation combined with bone grafting.