胫骨骨折手术治疗后不愈合的原因及预防

目的 探讨胫骨骨折因手术治疗所致不愈合的原因分析及预防方法。方法 对589例胫骨骨折（包括胫腓骨骨折）手术治疗，加压钢板内固定320例，其它固定方法269例，包括外固定架100例；其中121例行骨膜旋转移植，87例行带蒂或带血管复合组织皮瓣移植，112例行腓骨截骨术，97例行植骨术。结果 589例胫骨骨折仅13例发生骨不愈合，6例为坚硬的加压钢板取出后原骨折处再次发生骨折。其余均达骨性愈合，随访平均24个月。结论 正确选择内外固定装置及安放位置，保护好邻近骨膜并作骨膜放旋转移植，必要时作腓骨截骨术，胫骨中下段骨折常规植骨，胫骨骨不愈合和再骨折发生率是可以预防的。

The cause and prevention of nonunion after open reduction of the tibia fracture

Objective:To study the cause and the method of prevention of nonunion after open reduction of fracture of the tibia Methods:589 cases of tibial fractures(including fractures of the tibia and fibula)were treated with open reduction;of them 320 cases were treated with internal fixation by the compressed steel plate and 269 cases with the other methods of fixation;100 cases were treated with the external fixation frame.121 cases had periosteum rotational transplantation and 87 cases had vascular pedicled composite tissue flap transplantation.112 cases had osteotomy of the fibula and 97 cases had bone grafting. Results:In 589 cases of tibial fractures,there were only 13 nonunions.6 cases had refractures again after removal of the compressed steel plate.All the other cases had Others solid bone union.The follow up period averaged 24 months. Conclusion: The external or intetnal fixation device with accurate reduction of the fracture and good protection of the adjacent periosteum are important topic for the prevention of nonunion.A circumferential transplantation of the periosteum and sometimes osteotomy of the fibula might indication for the achievement of bony union.In selected case bone graft is also indicated for the prevention of nonunion fracture.