交锁髓内钉结合自体髂骨移植治疗尺骨骨折不愈合的疗效与安全性研究

目的探讨尺骨交锁髓内钉结合自体髂骨移植治疗尺骨骨折不愈合的疗效与安全性。方法自2004年7月～2008年7月,对13例行手术或非手术治疗后发生尺骨骨折不愈合的患者行自体髂骨植骨,尺骨交锁髓内钉内固定术。其中男性9例,女性4例;年龄17～52岁,平均31.3岁。术后石膏固定4～8周,平均6.6周。拆除石膏后即开始主动和被动功能锻练。X-线片评价骨折愈合情况,Rating系统评分评价术后疗效与安全性。结果 13例患者术后均获得随访,平均16.1月（9～21月）。X-线片显示：12例（92%）实现骨折一期临床愈合,愈合时间平均5.6月（4～8月）。1例术后14月因骨折未愈合行自体带血管蒂腓骨移植并更换髓内钉,二次手术后6月骨折愈合。所有13例患者的Rating系统评分：优良5例（38%）,满意6例（46%）,不满意1例（8%）,失败1例（8%）。治疗及随访期间均未发生严重并发症。结论交锁髓内钉结合自体髂骨移植是治疗尺骨骨折不愈合的一种安全有效的方法。

Curative Effect and Safety Study of Intramedullary Nailing with Autologous Iliac Bone Grafting for Treatment of Nonunion of Ulnar Fracture

Objective To evaluate the curative effect and safety of ulnar nonunions with interlocking intramedullary nails and iliac bone grafts.Methods During the period of July 2004 to July 2008,13 patients who had accepted nonoperative or operative treatment and diagnosed as ulnar nonunion were considered for the treatment of interlocking intramedullary nails together with autogenous bone graft.There were 9 men and 4 women with an average age of 31.3 years（17～ 52 years）.Plaster was used for immobilization postoperation ranging from 4 ～8weeks with an average of 6.6 weeks.Passive and active motion were encouraged immediately after putting off the plaster.To evaluate union with X-ray pictures and evaluate the postoperative function with Rating system.Results All of the 13 patients accepted follow-up,with an average time of 16.1 months（9～21months）.The X-ray pictures showed that one-stage union was in 12 patients（92%）,with a meaning healing time of 5.6 months（4～8 months）.One patient had to be performed with the treatment of vascularized fibular graft and changing the nail for 14 months of nonunion,then achieved union 6 months after the second operation.The Rating system scores of the 13 patients showed： 5 patients（38%） had excellent results;6 patients（46%） had satisfactory results;1 patient（8%） had satisfactory result and 1 patient（8%） had failure result.No severe complications were observed during the treatment and follow-up.Conclusion Treatment of ulnar nonunions with interlocking intramedullary nails and iliac bone grafts is safe and effective.