手术治疗四肢骨折后骨不连263例

目的回顾性分析四肢骨折后骨不连的发生原因及手术治疗结果。方法1996年5月～2005年8月共收治263例四肢骨折后骨不连患者。骨不连部位：股骨近端13例,股骨干57例,胫骨81例,肱骨51例,尺桡骨44例,锁骨5例,髋臼2例,舟骨3例,距骨4例,其它3例。本组患者全部采用手术治疗,其中交锁髓内钉固定157例,钢板螺钉固定72例,外固定架固定34例。植骨方法：单纯自体松质骨移植189例,自体松质骨混合其它材料移植57例,带血管蒂的游离骨瓣移植10例,自体骨髓移植4例,骨加压延长术3例。结果本组患者发生骨不连的主要原因为应力干扰和局部血供差,其次为感染、骨缺损及骨折复位不良、对位差、骨折间隙过大。242例患者获平均14．3个月(4～48个月)随访。242例患者均获骨性愈合,骨折愈合时间平均为5．3个月(3～18个月)。其中220例患者(90．9%)肢体功能优,无跛行等后遗症；22例患者(9．1%)遗留邻近关节活动受限、肢体短缩及跛行等许发症。结论骨不连的发生原因是多方面的,如果在治疗骨折时足够重视,多数骨不连可以避免。骨不连采用手术重新固定加自体植骨可获得良好疗效。

Surgical management of 263 cases of extremity nonunions

Objective To retrospectively analyze the causes anti surgical management of nonunion at upper and lower extremities treated during the recent 10 years.Methods Two hundred and sixty-three cases of ex- tremity nonunion frum May 1996 to August 2005 were retrospectively studied.The nonunion was located at the proximal femur in 13 cases,at the femoral shaft in 57 cases,at the tibia in 81 cases,at the humerus in 51 cases, at the radius or ulna in 44 cases,at the clavicle in five cases,and at the other sites of extremity in 12 cases.They were all treated with open reduction and fixation combined with autogenous bone grafting.One hundred and fifty-seven cases were fixed with interlocked nails,72 with plate and screw,and 34 with external fixators.One hundred and eighty-nine cases received graft of simple autogenous cancellous bone,57 cases graft of autogenous cancellous bone combined with other artificial materials,10 graft of free vascularized bone flap,four graft of autologous bone marrow,and three compression lengthening.Results The main causes for nonunion in this series were found to be stress interference,poor local blood supply,infection,bone defects,poor reduction and excessive fracture gap.Two hundred and forty-two patients were available for follow-ups.The mean follow-up was 14.3 months (range,4 to 48 months).Bony union was achieved in all the patients after a mean of 5.3 months(range,3 to 18 months).Functional results were excellent in 220(90.9%)patients.Twenty-two(9.1%)patients had such com- plications as stiffness of neighboring joints,lameness and pain.Conclusions Nonunion usually results from multiple causes.In most cases,nonunion can be avoided if effective measures can be taken in the initial treatment of fractures.Successful treatment of nonunions often requires surgical actions,good outcome can be expected after operative fixation combined with autogenous bone grafting.