附加锁定加压钢板固定联合植骨治疗股骨转子下无菌性骨不连的疗效分析

目的探讨附加锁定加压钢板联合植骨治疗股骨转子下无菌性骨不连的疗效。方法回顾性分析2016年10月至2019年10月期间上海交通大学附属第六人民医院骨科收治的32例股骨转子下骨折髓内钉固定术后无菌性骨不连患者资料。男25例,女7例;年龄为27~68岁,平均50.5岁;骨不连时间为9~24个月,平均12.2个月。骨不连根据Weber-Cech分型:血管丰富型9例,缺血型23例。所有患者均不取原髓内钉、采用附加锁定加压钢板固定并联合自体髂骨植骨治疗。记录患者的骨愈合时间、患髋功能及并发症发生情况等。结果32例患者术后获6~24个月(平均12.9个月)随访。所有患者骨不连均获临床及影像学愈合,临床愈合时间为3~8个月,平均5.2个月;影像学愈合时间为6~10个月,平均7.4个月。末次随访时根据Sanders髋关节创伤后评分标准评定疗效:优28例,良4例,优良率为100%(32/32);根据髋关节Harris评分标准评定疗效:优21例,良10例,可1例,优良率为96.9%(31/32)。随访期间无一例患者发生感染、内固定物松动及断裂等并发症。结论附加锁定加压钢板联合髂骨植骨治疗股骨转子下骨折髓内钉固定术后无菌性骨不连疗效良好,是一种可靠、有效的方法。

An additional augmentative locking compression plate combined with bone graft for treatment of aseptic subtrochanteric fracture nonunion after intramedullary nailing

Objective To investigate the efficacy of an additional augmentative locking compression plate combined with bone graft for aseptic subtrochanteric fracture nonunion after intramedullary nailing.Methods From October 2016 to October 2019,32 patients(25 males and 7 females)were treated at Department of Orthopedics,The Sixth People's Hospital Affiliated to Shanghai Jiaotong University for aseptic subtrochanteric fracture nonunion after intramedullary nailing.Their ages ranged from 27 to 68 years(average,50.5 years)and their nonunion time from 9 to 24 months(average,12.2 months).According to the Weber-Cech classification for nonunions,9 cases belonged to the highly vascular type and 23 to the ischemic type.With the original intramedullary nails retained,all patients were fixated with an additional augmentative locking compression plate before simultaneous autologous iliac bone grafting.All patients were followed up regularly for fracture union,function of the affected hip and complications.Results The 32 patients were followed up for 6 to 24 months(average,12.9 months).All nonunions obtained clinical and imaging union.The clinical union time ranged from 3 to 8 months(average,5.2 months),and the imaging union time from 6 to 10 months(average,7.4 months).At the last follow-up,the therapeutic efficacy was evaluated as excellent in 28 cases and as good in 4,giving a good to excellent rate of 100%(32/32),according to the Sanders scoring for post-traumatic hip joint;the efficacy was evaluated as excellent in 21 cases,as good in 10 cases and as fair in one,giving a good to excellent rate of 96.9%(31/32),according to the Harris hip scoring.No such complications occurred as infection or loosening or breakage of internal fixation.Conclusion An additional augmentative locking compression plate combined with bone graft is a reliable and effective treatment for aseptic subtrochanteric fracture nonunion after intramedullary nailing.