中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
27期
1902-1906
,共5页
张建政%孙天胜%刘智%李连华%任继鑫%刘树清%胥少汀
張建政%孫天勝%劉智%李連華%任繼鑫%劉樹清%胥少汀
장건정%손천성%류지%리련화%임계흠%류수청%서소정
骨折固定术,髓内%骨折固定术,内%骨折%骨干
骨摺固定術,髓內%骨摺固定術,內%骨摺%骨榦
골절고정술,수내%골절고정술,내%골절%골간
Fracture fixation,intramedullary%Fracture fixation,internal%Fracture healing%Diaphyses
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.
目的 探討髓內釘固定後長骨榦肥大性骨不連的原因及附加鋼闆的手術適應證.方法 1998年4月至2009年4月,應用附加鋼闆治療14例髓內釘固定後長骨榦肥大性骨不連,其中股骨榦9例,肱骨3例,脛骨2例.2例為骨榦上1/3,6例為骨榦中1/3,6例為骨榦下1/3.採用4~6孔鈦閤金限製接觸性窄動力鋼闆,4~6枚皮質骨螺釘固定.8例骨不連間隙>5 mm,5例採用單純髂骨植骨,3例圍骼生和髂骨混閤植骨.6例<5mm,3例植入固骼生,另3例將脩整的骨痂重新植入.術後保護性活動防止主釘斷裂失效,逐漸恢複術前活動水平,術後1、3、6、12箇月臨床及影像學隨診.結果 8例取髂骨植骨和附加鋼闆固定手術時間共60~120 min,齣血量100~300 ml.6例單純附加鋼闆手術時間40~100 min,齣血量60~100 ml.供骨區疼痛5例,3例1箇月內緩解,2例3箇月後緩解,無感染、鋼闆螺釘鬆動、斷裂等.平均愈閤時間8箇月,6例術後6~11箇月取齣髓內釘和鋼闆.結論 鏇轉不穩定是導緻肥大性骨不連的原因,股骨、脛骨骨骺耑肥大性骨不連、粉碎性骨摺骨不連以及肱骨榦骨不連是附加鋼闆的手術適應證.
목적 탐토수내정고정후장골간비대성골불련적원인급부가강판적수술괄응증.방법 1998년4월지2009년4월,응용부가강판치료14례수내정고정후장골간비대성골불련,기중고골간9례,굉골3례,경골2례.2례위골간상1/3,6례위골간중1/3,6례위골간하1/3.채용4~6공태합금한제접촉성착동력강판,4~6매피질골라정고정.8례골불련간극>5 mm,5례채용단순가골식골,3례위격생화가골혼합식골.6례<5mm,3례식입고격생,령3례장수정적골가중신식입.술후보호성활동방지주정단렬실효,축점회복술전활동수평,술후1、3、6、12개월림상급영상학수진.결과 8례취가골식골화부가강판고정수술시간공60~120 min,출혈량100~300 ml.6례단순부가강판수술시간40~100 min,출혈량60~100 ml.공골구동통5례,3례1개월내완해,2례3개월후완해,무감염、강판라정송동、단렬등.평균유합시간8개월,6례술후6~11개월취출수내정화강판.결론 선전불은정시도치비대성골불련적원인,고골、경골골후단비대성골불련、분쇄성골절골불련이급굉골간골불련시부가강판적수술괄응증.
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.