CAJ | 학술논문

目的探讨附加钢板治疗髓内钉固定后股骨萎缩性骨不连的手术适应证和操作技术.方法1999年6月-2009年6月,应用附加钢板合并开放植骨治疗12例髓内钉固定后股骨萎缩性骨不连.小切口微创清除骨折端肉芽组织,硬化骨去皮质化,足量髂骨纵形平铺于骨不连间隙和骨皮质骨床上,选择5～6孔钛合金限制接触型动力接骨板,3.0 mm克氏针钻孔,4～6枚皮质骨螺钉双皮质固定.术后保护性负重,1,3,6,12个月临床与影像学评估.结果全部获得骨性愈合,随访时问7 ～26个月,平均17.4个月.取髂骨植骨并附加钢板固定手术时间共50～120 min,平均77.5 min;出血量150～350 ml,平均252 ml.术后供骨区疼痛9例,7例1个月内缓解,2例3个月后缓解.临床骨性愈合时间5～9个月,平均7.1个月;影像学愈合时间7～12个月,平均9.4个月.无感染、钢板螺钉松动、断裂等.结论附加钢板合并植骨适用于髓内钉固定后股骨干骺端骨不连、AO分型B型骨折骨不连、骨缺损>1 cm以及扩髓更换髓内钉失败的萎缩性骨不连.
목적 탐토부가강판치료수내정고정후고골위축성골불련적수술괄응증화조작기술.방법1999년6월-2009년6월,응용부가강판합병개방식골치료12례수내정고정후고골위축성골불련.소절구미창청제골절단육아조직,경화골거피질화,족량가골종형평포우골불련간극화골피질골상상,선택5～6공태합금한제접촉형동력접골판,3.0 mm극씨침찬공,4～6매피질골라정쌍피질고정.술후보호성부중,1,3,6,12개월림상여영상학평고.결과전부획득골성유합,수방시문7 ～26개월,평균17.4개월.취가골식골병부가강판고정수술시간공50～120 min,평균77.5 min;출혈량150～350 ml,평균252 ml.술후공골구동통9례,7례1개월내완해,2례3개월후완해.림상골성유합시간5～9개월,평균7.1개월;영상학유합시간7～12개월,평균9.4개월.무감염、강판라정송동、단렬등.결론부가강판합병식골괄용우수내정고정후고골간후단골불련、AO분형B형골절골불련、골결손>1 cm이급확수경환수내정실패적위축성골불련.
Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.