椎间盘镜下微创植骨治疗下肢骨折术后骨不连

目的探讨在椎间盘镜下微创植骨治疗股骨、胫骨骨折术后骨不连的疗效。方法 2004年8月-2008年8月,采用椎间盘镜下植骨治疗股骨、胫骨骨折术后骨不连患者40例。男23例,女17例;年龄20～63岁,平均41.5岁。骨折后初次手术采用股骨带锁髓内钉固定治疗12例,钢板固定16例;胫骨带锁髓内钉固定9例,钢板固定3例。内固定术后10～16个月发生骨不连。X线片示肥大型骨不连24例,正常型3例,萎缩型13例。结果患者手术时间40～80 min,平均61min;出血量80～130 mL,平均100 mL。住院时间6～11 d,平均8.1 d。患者切口均Ⅰ期愈合,无感染及血管、神经损伤等并发症发生。40例均获随访,随访时间10～16个月,平均12.3个月。X线片示40例骨折均愈合,愈合时间4～10个月,平均6.8个月。无患肢疼痛及功能障碍,无内固定失效。结论经椎间盘镜下微创植骨治疗股骨、胫骨骨折内固定术后骨不连是一种微创、有效的治疗方法。

Treatment of postoperative nonunion of fracture of lower limb with bone grafting by intervertebral disc endoscope

Objective To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperative nonunion of fracture of lower limb.Methods Between August 2004 and August 2008,40 patients(23 males and 17 females) with postoperative nonunion of femoral and tibial fracture,aged 20-63 years(mean,41.5 years) were treated.Nonunion of fracture occurred at 10-16 months after internal fixation.During the first operation,the internal fixation included interlocking intramedullary nailing of femoral fracture in 12 cases and plate in 16 cases,and interlocking intramedullary nailing of tibial fractures in 9 cases and plate in 3 cases.The X-ray films showed hypertrophic nonunion in 24 cases,common nonunion in 3 cases,and atrophic nonunion in 13 cases.Results The average operation time was 61 minutes(range,40-80 minutes),and the blood loss was 80-130 mL(mean,100 mL).The hospitalization time were 6-11 days(mean,8.1 days).Incisions healed by first intention in all patients with no complication of infection or neurovascular injury.Forty patients were followed up 10-16 months(mean,12.3 months).The X-ray films showed that all patients achieved healing of fracture after 4-10 months(mean, 6.8 months).No pain,disfunction,or internal fixation failure occurred.Conclusion Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.