附加钢板治疗髓内钉固定后长骨干肥大性骨不连

目的 探讨髓内钉固定后长骨干肥大性骨不连的原因及附加钢板的手术适应证.方法 1998年4月至2009年4月,应用附加钢板治疗14例髓内钉固定后长骨干肥大性骨不连,其中股骨干9例,肱骨3例,胫骨2例.2例为骨干上1/3,6例为骨干中1/3,6例为骨干下1/3.采用4～6孔钛合金限制接触性窄动力钢板,4～6枚皮质骨螺钉固定.8例骨不连间隙>5 mm,5例采用单纯髂骨植骨,3例围骼生和髂骨混合植骨.6例<5mm,3例植入固骼生,另3例将修整的骨痂重新植入.术后保护性活动防止主钉断裂失效,逐渐恢复术前活动水平,术后1、3、6、12个月临床及影像学随诊.结果 8例取髂骨植骨和附加钢板固定手术时间共60～120 min,出血量100～300 ml.6例单纯附加钢板手术时间40～100 min,出血量60～100 ml.供骨区疼痛5例,3例1个月内缓解,2例3个月后缓解,无感染、钢板螺钉松动、断裂等.平均愈合时间8个月,6例术后6～11个月取出髓内钉和钢板.结论 旋转不稳定是导致肥大性骨不连的原因,股骨、胫骨骨骺端肥大性骨不连、粉碎性骨折骨不连以及肱骨干骨不连是附加钢板的手术适应证.

Therapeutic efficacy of augmentative plate fixation in long-bone hypertrophic nonunion subsequent to intramedullary nailing

Objective To determine the therapeutic efficacy of augmentation plate fixation in nonunion of long-bone fracture after interlocking intramedullary nailing. Methods From April 1998 to April 2009, 14 patients with long-bone hypertrophic nonunion after intramedullary nail internal fixation were treated with augmentative plate. There were nine patients with nonunion of femur, three of humerus and two of tibia. After implanting the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of bone shaft In all patients, the rotational instability of fracture site was verified intra-operatively in all cases. However, motion disappeared after plate augmentation. Results All patients achieved radiological solid union at an average of 8 months ( range: 6-11). Hardware was removed in six cases at 6-11 months post-operation. No infection, hardware loosening or rupture was found. Conclusion The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. Augmentation plate fixation is indicated for femoral and tibial nonunion of proximal or distal metaphyseal-diaphyseal junctional areas, primary comminuted fracture and humeral nonunion after intramedullary nailing.