CAJ | 학술논문

目的探讨锁定钢板内固定联合植骨治疗股骨骨不连或伴骨缺损的疗效。方法 2005年6月至2010年6月应用锁定钢板治疗80例股骨骨折术后骨不连或伴骨缺损的患者，男60例，女20例；年龄8～68岁，平均38.2岁。骨不连部位：股骨近端16例，股骨远端40例，股骨干24例。骨不连原因：内固定失效60例，外固定失败5例，感染15例。骨不连病理分型：非感染性骨不连65例，其中肥大型15例，营养不良型10例，萎缩型40例（其中20例伴有骨缺损）；感染性骨不连15例。骨不连病程6～150个月，平均16.5个月。58例患者使用微创内固定系统钢板固定，22例患者使用锁定加压钢板固定。所有患者均进行植骨，其中自体髂骨移植35例，局部滑行加骨痂植骨10例，自体植骨结合同种异体松质骨移植8例，同种异体松质骨结合人工骨移植7例，吻合血管游离腓骨移植20例。结果所有患者术后获6 ～ 36个月（平均13.8个月）随访。骨不连均在4～8个月（平均5.3个月）牢固愈合。无切口感染、内置物断裂及松动等并发症发生。16例股骨近端骨不连患者采用Sanders 创伤后髋关节评分标准评定疗效：优10例，良5例，差1例，优良率为93.8％。40例股骨远端骨不连患者采用美国膝关节协会评分系统( KSS)评定疗效：优25例，良12例，差3例，优良率为92.5％。24例股骨干骨不连患者采用Sanders创伤后髋关节评分标准和KSS评定疗效：优21例，良2例，差1例，优良率为95.8％。结论锁定钢板内固定辅以植骨能明显促进骨愈合，是治疗股骨骨不连或伴骨缺损的有效方法之。
목적 탐토쇄정강판내고정연합식골치료고골골불련혹반골결손적료효。방법 2005년6월지2010년6월응용쇄정강판치료80례고골골절술후골불련혹반골결손적환자，남60례，녀20례；년령8～68세，평균38.2세。골불련부위：고골근단16례，고골원단40례，고골간24례。골불련원인：내고정실효60례，외고정실패5례，감염15례。골불련병리분형：비감염성골불련65례，기중비대형15례，영양불량형10례，위축형40례（기중20례반유골결손）；감염성골불련15례。골불련병정6～150개월，평균16.5개월。58례환자사용미창내고정계통강판고정，22례환자사용쇄정가압강판고정。소유환자균진행식골，기중자체가골이식35례，국부활행가골가식골10례，자체식골결합동충이체송질골이식8례，동충이체송질골결합인공골이식7례，문합혈관유리비골이식20례。결과 소유환자술후획6 ～ 36개월（평균13.8개월）수방。골불련균재4～8개월（평균5.3개월）뢰고유합。무절구감염、내치물단렬급송동등병발증발생。16례고골근단골불련환자채용Sanders 창상후관관절평분표준평정료효：우10례，량5례，차1례，우량솔위93.8％。40례고골원단골불련환자채용미국슬관절협회평분계통( KSS)평정료효：우25례，량12례，차3례，우량솔위92.5％。24례고골간골불련환자채용Sanders창상후관관절평분표준화KSS평정료효：우21례，량2례，차1례，우량솔위95.8％。결론 쇄정강판내고정보이식골능명현촉진골유합，시치료고골골불련혹반골결손적유효방법지。
Objective To evaluate the clinical effects of internal fixation with locking plates and bone grafting for femoral nonunion and /or bone defects.MethodsFrom June 2005 to June 2010, 80 cases of nonunion of femoral fractures and/or bone defects were treated with internal locking plating and bone grafting. There were 60 males and 20 females, with a mean age of 38.2 years (range, 8 to 68 years) and a mean nonunion history of 16.5 months (range, 6 to 150 months) . The causes for nonunion were failure of internal fixation in 60 cases, failure of external fixation in 5 cases and infection in 15 cases. There were 15 hypertrophic, 10 malnourished, 40 atrophic (including 20 bone defects) and 15 infective nonunions.Fifty-eight cases were treated with less invasive stabilization system and 22 cases with locking compression plate. Bone grafting was performed for all cases, including 35 cases of autologous iliac bone grafting, 10 cases of local sliding plus bony callus grafting, 8 cases of autologous iliac bone plus allograft bone grafting, 7 cases of allograft bone plus Wright DBM artificial bone grafting and 20 cases of free vascularized fibular grafting.ResultsAll cases were followed up for a mean period of 13.8 months (range, 6 to 36 months). All cases healed after a mean duration of 5.3 months (range, 4 to 8 months) without wound infection or fixator failure.By the Sanders scale, of the 16 cases of proximal femoral nonunion, the hip functions were rated as excellent in 10, good in 5 and fair in one, with an excellent to good rate of 93.8％. By the American Knee Society Score (KSS), of the 40 cases of distal femoral nonunion, the knee function was rated as excellent in 25, good in 12 and fair in 3, with an excellent to good rate of 92. 5％. By the Sanders and KSS systems, of the 24 cases of femoral shaft nonunion, the hip and knee functions were rated as excellent in 21, good in 2 and fair in one,with an excellent to good rate of 95. 8％.ConclusionAs internal fixation with locking plates and bone grafting can significantly promote fracture union, it is an effective treatment for nonunion of femoral fractures.