外固定技术治疗骨折内固定术后难治性骨不连并骨缺损

目的 探讨外固定技术不植骨治疗骨折内固定术后难治性骨不连并骨缺损的临床疗效.方法 自2002年4月至2008年12月收治17例骨折内固定术后难治性骨不连及骨缺损患者,男12例,女5例;年龄ll～50岁,平均34.7岁.骨不连部位:胫骨10例,股骨5例,肱骨2例;骨不连时间8～21个月,平均16.3个月;既往接受手术次数1～3次,平均1.6次;骨缺损长度2.5～11.0 cm,平均3.5 cm.采用短缩加压结合延长和骨节段延长转位两种外固定基本方法治疗,观察骨折愈合及伤肢功能情况.结果 17例骨不连均骨性愈合,愈合时间3～21个月,平均5.2个月.12例伴有肢体短缩的骨不连并骨缺损患者同期或二期重建了肢体长度,达到了肢体长度均衡,平均骨延长4.8 cm,愈合时间4～11个月,平均5.2个月,骨愈合指数平均32 d/cm.结论 采用外固定技术治疗难治性骨不连并骨缺损,其弹性固定有利于骨折愈合,干骺端截骨延长有效重建了肢体长度,达到了肢体长度平衡并可早期下地活动,可视为一种疗效确切的微创生物学治疗技术.

External skeletal fixation technology to treat refractory nonunion in long bones following prior internal fixation

Objective To observe clinical outcomes of external skeletal fixation technology without bone graft in treatment of complex bone nonunion and defect following prior internal fixation. Methods From April, 2002 to December, 2008 in our hospital, a total of 17 patients with complex bone nonunion and bone defect were treated with external skeletal fixation withont bone graft. They were 12 men and 5 women,aged 11 to 50 years (average, 34. 7 years). The nonunion involved tibia in 10, femur in 5 and humerus in 2 cases. The duration for nonunion ranged from 8 to 21 months (average, 16.3 months). Bone defects ranged from 2. 5 to 11.0 cm (average, 3.5 cm) . End-to-end compression followed by lengthening and segmental bone transport by lengthening were conducted for the management. Twelve cases complicated with bone defect or limb shortening received epiphysiotomy to restore the limb length in the period of compressive fixation. The patients were followed regularly to assess their healing of nonunion and defects. Results According to clinical follow-up, all patients obtained fracture healing after a mean time of 5. 2 months (range, 3 to 21 months). The 12 patients with bone defects sustained a mean bone lengthening of 4. 8 cm, obtaining a balance in limb length. Their healing time ranged from 4 to 11 months (average, 5.2 months). Their mean bone union index was 32 d/cm.Conclusions The plastic external skeletal fixation can promote bone healing. Bone lengthening through epiphysiotomy can restore the balance in limb length without bone graft. Therefore, this tecnology is an effective treatment for complex bone nonunion and defect in long bones.