下肢骨干骨折术后骨不连的原因分析及手术治疗

目的探讨下肢骨干骨折术后骨不连的原因、再次手术治疗方式及临床疗效。方法自2010-01—2012-06诊治下肢骨干骨折术后骨不连41例,分析骨不连原因,选择更换内固定物或保留髓内钉附加接骨板固定,并对营养不良型和萎缩型骨不连取自体髂骨植骨。结果骨不连分型：肥大型7例,营养不良型19例,萎缩型15例。27例原骨折固定技术存在明显力学错误,14例嗜烟。再次手术后获15~34（21.7±9.3）个月随访,术后切口均一期愈合。骨折均骨性愈合,股骨干愈合时间（8.6±3.3）个月,胫骨干愈合时间（9.3±4.4）个月。临床疗效按Johner-Wruhs评分标准：股骨干优良率90.0%,胫骨干优良率90.1%。结论骨折断端的血供被破坏、骨折不稳定、嗜烟是下肢骨干骨折术后骨不连的主要原因,针对不同原因骨不连而采用恰当的手术治疗能取得良好的疗效。

Cause analysis and operative treatment for nonunion of shaft fracture of lower extremity

Objective To explore the reason and discuss operative treatment for nonunion of shaft fracture of lower extremity. Methods From January 2010 to June 2012, 41 cases of nonunion of shaft fractures of lower extremity were treated in our department. The nonunion reasons were surveyed, and nonunions were treated with internal fixation change or augmentation plating with a retained intramedullary nail, combined with autogenous iliac bone grafting for oligotrophic and atrophic nonunions. Results There were 7 hypotrophic, 19 oligotrophic and 15 atrophic nonunions. Twenty seven cases had the obvious technical errors in the primary surgical treatment, and 14 cases were smokers. All patients were followed up for （21.7±9.3）months on average. All the incisions healed by first intention, and an cases obtained bone union. The anverage time of bone union was （8.6±3.3）months in femur, while （9.3±4.4）months in tibia. According to the Johner-Wruhs score system, the excellent and good rate was 90.0% in femur and 90.1% in tibia. Conclusion Insufficient blood supply, inappropriate mechanical environment of the fracture, smoking are the main reasons for the development of a nonunion. To achieve satisfactory outcomes, an individual surgical procedure should be chosen according to the specific nonunion reasons.