锁定钢板治疗髓内固定失败致无菌性骨不连

目的 评价锁定钢板治疗因髓内钉固定失败而造成的无菌性骨不连的疗效.方法 2004年1月至2006年12月,因髓内钉固定失败而造成的四肢长骨无菌性骨小连患者38例,男26例,女12例;年龄9-70岁,平均39.2岁;骨不连时间6-84个月,平均16.2个月.按骨不连骨折端形态Judet分类法分型:肥大型9例,营养不良型10例,萎缩型19例,其中15例形成假关节.骨不连的部位:股骨20例,胫骨15例,肱骨3例,其中21例(占55.3%)位于长骨干骺端附近.该组病例均采用锁定钢板固定以及联合骨移植进行治疗.结果 患者均获得随访,随访时间6～20个月,平均11.6个月.骨不连均愈合,愈合时间4～8个月,平均5.3个月.3例(7.9%)出现切口表面感染,经治疗后均痊愈;1例(2.6%)切口延迟愈合;1例(2.6%)出现肢体短缩约2 cm.无一例发生骨折畸形愈合.末次随访时关节活动度较术前显著改善,其中30例(78.9%)功能优良,7例(18.4%)可,1例(2.6%)差.结论 对于髓内钉固定失败而造成的无菌性骨不连,采用锁定钢板进行固定是一种疗效确切的治疗方法,尤其是针对干骺端附近的骨不连.锁定钢板联合骨移植治疗能提供可靠的固定稳定性和骨诱导、骨传导作用.

Treatment of aseptic non-unions after intramedullary nailing interfixation with locking plate

Objective To evaluate the clinical outcomes of locking plate to treat aseptic non-unions after intramedullary nailing interfixation.nethods From January 2004 to December 2006.a total of 38 consecutive patients with long bone non-unions at extremities after intramedullary nailing interfixation were treated.There were 12 females and 26 males with a mean age of 39.2 years (range 9-70 years) and with a mean time of non-union 16.2 months (range 6-84 months).There were 9 hypertrophic non-unions,10 malnourished non-unions and 19 atrophic non-unions according to Judet classification of non-union morpheus.And there were 15 synovial pseudarthrosises in those eases.The non-unions happeded in fetours 20 Datients,tibias in 15 and humeruses in 3.21 (55.3%) of them were located nearby the metaphyseal of the long bones.Patients were treated with locking plate combinating with bone grafting for the non-union of intramedullary nailing.The postoperative outcomes and ioint functions of all patients were clinically evaluated.Resuits All patients were followed up for a mean time of 11.6 months (range 6-20 months),and the non-unions healed after a mean 5.3 months (range 4-8 months) in all of the 38 patients.Only 3 cases (7.9%) suffered infected in superficial of the incision and one ease (2.6%) delayed healing of incision.1 case occured shortening in the leg about 2 cm.No malunion and any other further complications were found.For the funetion of joints,30 patients(78.9%)were excellent or good,7 patients(18.4%)were fair and 1 patient(2.6%) was poor by re-evaluating through a mean follow-up of 11.6 months.Conclusion It has been shewn that locking plate is an effective treatment for aseptic non-union after intramedullary nailing interfixed,especially in the area of the metaphyseal.And it can provide reliable stability and excellent osteoinductive and osteoconductive when it combined with bone graftings.