网状植骨治疗股骨中下段大段骨缺损的临床研究*

目的研究网状植骨结合钢板或外固定支架治疗股骨中下段骨折并大段骨缺损的临床效果,为基层医院治疗类似病例提供临床经验。方法我院自2008年8月-2011年3月共收治31例股中下段骨折并骨缺损患者,其中男性27例,女性4例,年龄16-43岁,平均21.7岁。术中采用残存自体骨或取髂骨,在残存大骨片及取髂骨周边钻孔,以可吸收缝线编织成网状,分别固定在近远端,网状腔中间填塞松质骨。固定方式采用普通钢板、锁定钢板、LISS钢板以及外固定支架固定。结果 31例骨折患者取得较好效果,其中22例均顺利愈合,6例出现钢板断裂,另3例发生感染及骨不连并发症,9例均在术后5-18月二次手术,效果良好。结论网状植骨结合钢板或外固定支架治疗股骨下段骨缺损效果良好,是治疗股骨中下段骨骨折并骨缺损的方法之一。内固定的材料、股骨髁间骨折、内侧植骨的可靠程度与远期钢板断裂及下肢内翻等并发症有一定关系。

Applications of retiecular bone-grafting in treating distal femoral fractures complieating with massibe bone defect

Objective To discuss the therapeutic effect of mesh bone graft combined with plate or external frame fixation in middle and lower femoral fracture with large bone defect,providing clinical experience for basic-level hospital.Methods From August 2008 to March 2011,31 patients ﹙27 males,4 females;age from 16 to 43,mean 21.7 years old﹚ suffered middle and lower femoral fracture with large bone defect were treated by primary or secondary operation.We woven the remaining autogenous bone or iliac bone with absorbable suture into a net,and then packed with cancellous bone,and fixed with plate or external frame.Results All patients achieved good effects,22 of which gained primary healing,while 6 plates broken and 3 cases complicated with infection and bone nonunion,both of which received secondary operation between 5 and 18 months postoperatively and gain good effects finally.Conclusion Mesh bone graft combined with plate,external fixation is feasible in treat middle and lower femoral fracture with large bone defect.But plate breakage and varus deformity were related with internal fixation instruments,femoral condyle fractures,and the reliability of bone grafting in medial condyle of femoral.