附加侧方钢板手术治疗下肢骨折行髓内钉内固定术后骨不连疗效观察

目的：探讨侧方钢板治疗下肢骨折髓内钉内固定术后骨不连的临床疗效。方法选取2010年3月至2014年1月期间在我院进行治疗的62例下肢骨折行髓内钉内固定术后骨不连的患者。按随机数表法将其分为对照组和观察组各31例，观察组采用保留髓内钉附加侧方钢板进行翻修手术治疗，对照组利用更换髓内钉进行翻修手术治疗，术后比较两组患者手术治疗的各项指标、随访情况、Johner-wruch评分。结果术后观察组患者的手术平均时间(96.13±14.52) min、术中出血量(429.53±213.62) ml、术中输血量(1.33±0.81) U和住院时间(12.45±1.47) d均少于对照组的(171.42±13.36) min、(798.34±415.11) ml、(3.21±2.23) U以及(18.42±1.58) d，差异均具有统计学意义(P<0.05)；随访发现，观察组患者的愈合时间为(6.1±0.2)个月，明显短于对照组的(9.2±0.4)个月，差异有统计学意义(P<0.05)；两组患者的Johner-wruch评分比较显示，观察组患者的总优良率(83.87%，26/31)明显高于对照组(64.52%，20/31)，差异有统计学意义(P<0.05)。结论保留髓内钉附加侧方钢板手术治疗下肢骨折行髓内钉内固定术后骨不连与更换髓内钉手术相比较，其操作更为简单、手术时间更为短、术中的出血量输血量更少、住院时间短、临床疗效更好，可在临床中推广使用。

Clinical efficacy of adding lateral plate in the treatment of nonunion after intramedullary nail fixation for lower extremity fractures

Objective To evaluate the clinical efficacy of adding lateral plate in the treatment of nonunion after intramedullary nail fixation in patients with lower extremity fractures. Methods Sixty-two patients of lower extremity fractures with nonunion after intramedullary nail fixation in our hospital from March 2010 to January 2014 were en-rolled in the study. The patients were divided into control group and observation group according to a random number ta-ble, each with 31 patients. The observation group reserved the intramedullary nail and added lateral plate for treatment, while the control group replaced the intramedullary nail. The surgery indicators, follow-up situation, Johner-wruch score were compared between the two groups. Results In the observation group, the average operation time, intraoperative blood loss, intraoperative blood transfusion and length of hospital stay were (96.13 ± 14.52) min, (429.53 ± 213.62) ml, (1.33 ± 0.81) U and (12.45 ± 1.47) d, respectively, which were significantly less than those in the control group of (171.42±13.36) min, (798.34±415.11) ml, (3.21±2.23) U and (18.42±1.58) d, P<0.05. During the follow-up, the healing du-ration of the patients in the observation group was significantly shorter than that in the control group, (6.1 ± 0.2) months vs (9.2±0.4) months, P<0.05. Comparison of Johner-wruch scores showed that the total excellent and good rate in the observa-tion group (83.87%, 26/31) was significantly higher than that in the control group (64.52%, 20/31), with statistically signifi-cant difference (P<0.05). Conclusion In the treatment of nonunion after intramedullary nail fixation for lower extremity fractures, adding lateral plate while reserving the intramedullary nail has the advantages of easier operation, shorter opera-tion time, less intraoperative blood loss, less intraoperative blood transfusion, shorter length of hospital stay, and better clini-cal efficacy, compared with replacing the intramedullary nail. It is worth to be extended in clinical practice.