CAJ | 학술논문

目的:回顾性评价采用锁定加压接骨板置入结合鱼鳞化自体骨移植治疗肱骨干骨折术后骨不愈合的疗效.方法:选择2005-08/2009-01郴州市湘南学院附属医院骨科收治的肱骨干骨折术后骨不愈合患者19例,男12例,女7例:年龄28-59岁,平均36岁;全部患者均采用锁定加压接骨板结合自体骨鱼鳞化移植进行治疗,操作要点:上臂后正中入路或外侧入路,首先保护好桡、尺神经,清除骨不愈合部位的瘢痕组织,打通骨髓腔,骨膜做有限剥离.利用微创接骨板内固定技术,接骨板应足够长,骨不愈合的两端至少各有三四枚自锁螺钉固定,锁钉应穿过双侧骨皮质,自体松质骨鱼鳞化植骨.结果:所有骨不愈合患者全部愈合,愈合时间6～8个月,平均7.2个月.2例术后出现桡神经牵拉性麻痹,经对症处理分别于术后3,6周逐渐恢复.7例仍遗留不同程度肩肘关节功能障碍,但不影响日常生活.无感染、螺钉松动及接骨板折断等并发症发生.结论:锁定加压接骨板治疗肱骨干骨折术后骨不愈合的优点在于螺钉与接骨板锁定为一体,不会出现单钉折断或接骨板松动的情况,自体松质骨移植与鱼鳞化去皮质技术联用,骨折治愈率更高.
목적:회고성평개채용쇄정가압접골판치입결합어린화자체골이식치료굉골간골절술후골불유합적료효.방법:선택2005-08/2009-01침주시상남학원부속의원골과수치적굉골간골절술후골불유합환자19례,남12례,녀7례:년령28-59세,평균36세;전부환자균채용쇄정가압접골판결합자체골어린화이식진행치료,조작요점:상비후정중입로혹외측입로,수선보호호뇨、척신경,청제골불유합부위적반흔조직,타통골수강,골막주유한박리.이용미창접골판내고정기술,접골판응족구장,골불유합적량단지소각유삼사매자쇄라정고정,쇄정응천과쌍측골피질,자체송질골어린화식골.결과:소유골불유합환자전부유합,유합시간6～8개월,평균7.2개월.2례술후출현뇨신경견랍성마비,경대증처리분별우술후3,6주축점회복.7례잉유류불동정도견주관절공능장애,단불영향일상생활.무감염、라정송동급접골판절단등병발증발생.결론:쇄정가압접골판치료굉골간골절술후골불유합적우점재우라정여접골판쇄정위일체,불회출현단정절단혹접골판송동적정황,자체송질골이식여어린화거피질기술련용,골절치유솔경고.
OBJECTIVE: To retrospectively evaluate the effect of locking compression plate (LCP) combined with scaled cancellous bone graft on postoperative nonunion of humeral shaft fracture. METHODS: A total of 19 cases with postoperative nonunion of humeral shaft fracture were collected from Department of Orthopaedics, Affiliated Hospital, Xiangnan University between August 2005 and January 2009. There were 12 males and 7 females, aging 28-59 years with the mean age of 36 years. All patients were treated with LCP fixation combined with scaled cancellous bone graft. The key points of the operation were as follows: beck-median or lateral approach, protection of the radial nerve and ulnar nerve, removal of the cicatrix, reopening of humeral canal, and limited periosteum striping. For minimally invasive plate osteosynthesis technique, length of LCP was appropriate, 3-4 locking screws at least were used on either stump, and double cortices were penetrated with locking screws and treated with scaled cancellous bone graft. RESULTS: All the fractures healed with a mean period of 7.2 months (from 6 to 8 months). Two cases showed temporary radial nerve palsy after the operation, which gradually recovered 3 and 6 weeks, respectively after appropriate treatment. Shoulder and elbow functions were somewhat impaired in 7 cases, but the dysfunction could not influence daily living. Infection, screw loosening, blade plate breakage, and other complications were not found. CONCLUSION:The integrity of locking screws and plate prevents screw breakage and plate loosening. The combination of autoallergic cancellous bone graft and scaled decorticating technique can improve healing of humeral shaft fracture.