中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2008年
4期
265-269
,共5页
张长青%陈圣宝%程相国%盛加根%李鸿帅%徐俊%曾炳芳
張長青%陳聖寶%程相國%盛加根%李鴻帥%徐俊%曾炳芳
장장청%진골보%정상국%성가근%리홍수%서준%증병방
骨折%不愈合%骨折固定术%内%内固定器%骨移植
骨摺%不愈閤%骨摺固定術%內%內固定器%骨移植
골절%불유합%골절고정술%내%내고정기%골이식
Fractures%ununited%Fracture fixation%internal%Internal fixators%Bone transplantation
目的 评价锁定钢板治疗因髓内钉固定失败而造成的无菌性骨不连的疗效.方法 2004年1月至2006年12月,因髓内钉固定失败而造成的四肢长骨无菌性骨小连患者38例,男26例,女12例;年龄9-70岁,平均39.2岁;骨不连时间6-84个月,平均16.2个月.按骨不连骨折端形态Judet分类法分型:肥大型9例,营养不良型10例,萎缩型19例,其中15例形成假关节.骨不连的部位:股骨20例,胫骨15例,肱骨3例,其中21例(占55.3%)位于长骨干骺端附近.该组病例均采用锁定钢板固定以及联合骨移植进行治疗.结果 患者均获得随访,随访时间6~20个月,平均11.6个月.骨不连均愈合,愈合时间4~8个月,平均5.3个月.3例(7.9%)出现切口表面感染,经治疗后均痊愈;1例(2.6%)切口延迟愈合;1例(2.6%)出现肢体短缩约2 cm.无一例发生骨折畸形愈合.末次随访时关节活动度较术前显著改善,其中30例(78.9%)功能优良,7例(18.4%)可,1例(2.6%)差.结论 对于髓内钉固定失败而造成的无菌性骨不连,采用锁定钢板进行固定是一种疗效确切的治疗方法,尤其是针对干骺端附近的骨不连.锁定钢板联合骨移植治疗能提供可靠的固定稳定性和骨诱导、骨传导作用.
目的 評價鎖定鋼闆治療因髓內釘固定失敗而造成的無菌性骨不連的療效.方法 2004年1月至2006年12月,因髓內釘固定失敗而造成的四肢長骨無菌性骨小連患者38例,男26例,女12例;年齡9-70歲,平均39.2歲;骨不連時間6-84箇月,平均16.2箇月.按骨不連骨摺耑形態Judet分類法分型:肥大型9例,營養不良型10例,萎縮型19例,其中15例形成假關節.骨不連的部位:股骨20例,脛骨15例,肱骨3例,其中21例(佔55.3%)位于長骨榦骺耑附近.該組病例均採用鎖定鋼闆固定以及聯閤骨移植進行治療.結果 患者均穫得隨訪,隨訪時間6~20箇月,平均11.6箇月.骨不連均愈閤,愈閤時間4~8箇月,平均5.3箇月.3例(7.9%)齣現切口錶麵感染,經治療後均痊愈;1例(2.6%)切口延遲愈閤;1例(2.6%)齣現肢體短縮約2 cm.無一例髮生骨摺畸形愈閤.末次隨訪時關節活動度較術前顯著改善,其中30例(78.9%)功能優良,7例(18.4%)可,1例(2.6%)差.結論 對于髓內釘固定失敗而造成的無菌性骨不連,採用鎖定鋼闆進行固定是一種療效確切的治療方法,尤其是針對榦骺耑附近的骨不連.鎖定鋼闆聯閤骨移植治療能提供可靠的固定穩定性和骨誘導、骨傳導作用.
목적 평개쇄정강판치료인수내정고정실패이조성적무균성골불련적료효.방법 2004년1월지2006년12월,인수내정고정실패이조성적사지장골무균성골소련환자38례,남26례,녀12례;년령9-70세,평균39.2세;골불련시간6-84개월,평균16.2개월.안골불련골절단형태Judet분류법분형:비대형9례,영양불량형10례,위축형19례,기중15례형성가관절.골불련적부위:고골20례,경골15례,굉골3례,기중21례(점55.3%)위우장골간후단부근.해조병례균채용쇄정강판고정이급연합골이식진행치료.결과 환자균획득수방,수방시간6~20개월,평균11.6개월.골불련균유합,유합시간4~8개월,평균5.3개월.3례(7.9%)출현절구표면감염,경치료후균전유;1례(2.6%)절구연지유합;1례(2.6%)출현지체단축약2 cm.무일례발생골절기형유합.말차수방시관절활동도교술전현저개선,기중30례(78.9%)공능우량,7례(18.4%)가,1례(2.6%)차.결론 대우수내정고정실패이조성적무균성골불련,채용쇄정강판진행고정시일충료효학절적치료방법,우기시침대간후단부근적골불련.쇄정강판연합골이식치료능제공가고적고정은정성화골유도、골전도작용.
Objective To evaluate the clinical outcomes of locking plate to treat aseptic non-unions after intramedullary nailing interfixation.nethods From January 2004 to December 2006.a total of 38 consecutive patients with long bone non-unions at extremities after intramedullary nailing interfixation were treated.There were 12 females and 26 males with a mean age of 39.2 years (range 9-70 years) and with a mean time of non-union 16.2 months (range 6-84 months).There were 9 hypertrophic non-unions,10 malnourished non-unions and 19 atrophic non-unions according to Judet classification of non-union morpheus.And there were 15 synovial pseudarthrosises in those eases.The non-unions happeded in fetours 20 Datients,tibias in 15 and humeruses in 3.21 (55.3%) of them were located nearby the metaphyseal of the long bones.Patients were treated with locking plate combinating with bone grafting for the non-union of intramedullary nailing.The postoperative outcomes and ioint functions of all patients were clinically evaluated.Resuits All patients were followed up for a mean time of 11.6 months (range 6-20 months),and the non-unions healed after a mean 5.3 months (range 4-8 months) in all of the 38 patients.Only 3 cases (7.9%) suffered infected in superficial of the incision and one ease (2.6%) delayed healing of incision.1 case occured shortening in the leg about 2 cm.No malunion and any other further complications were found.For the funetion of joints,30 patients(78.9%)were excellent or good,7 patients(18.4%)were fair and 1 patient(2.6%) was poor by re-evaluating through a mean follow-up of 11.6 months.Conclusion It has been shewn that locking plate is an effective treatment for aseptic non-union after intramedullary nailing interfixed,especially in the area of the metaphyseal.And it can provide reliable stability and excellent osteoinductive and osteoconductive when it combined with bone graftings.