CAJ | 학술논문

目的探讨自体髂骨改良结构植骨治疗四肢骨不连的临床疗效. 方法回顾性分析2010年5月至2011年5月收治的60例四肢骨不连患者资料,男45例,女15例；年龄13～68岁,平均39.2岁.骨不连部位:肱骨干7例,胫腓骨19例,股骨干27例,桡骨远端4例,锁骨3例.骨不连按照Weber分型:肥大型3例,萎缩型15例,缺血型37例,假关节型5例.骨不连病程:6～25个月,平均12.5个月.入院前手术次数:1次42例,2次17例,3次1例.入院前固定方式:钢板固定45例,髓内钉固定8例,外固定支架固定7例.术中均采用自体髂骨改良结构植骨,并应用锁定钢板桥接内固定.术后随访患者,记录患者骨愈合时间及并发症发生情况等. 结果 60例患者术后获6 ～ 24个月(平均12.8个月)随访.59例骨不连患者于术后4～8个月(平均5.3个月)获愈合；1例股骨干骨不连患者术后6个月出现钢板断裂,入院再次行植骨,并在植骨区附加1块重建钢板加强固定,6个月后完全愈合.所有患者均无感染、畸形、双下肢不等长、取骨区疼痛等并发症发生. 结论自体髂骨改良结构植骨能够最大程度地发挥植骨块的成骨效应,使植骨块迅速成活,从而达到治愈四肢骨不连的目的.
목적 탐토자체가골개량결구식골치료사지골불련적림상료효. 방법 회고성분석2010년5월지2011년5월수치적60례사지골불련환자자료,남45례,녀15례；년령13～68세,평균39.2세.골불련부위:굉골간7례,경비골19례,고골간27례,뇨골원단4례,쇄골3례.골불련안조Weber분형:비대형3례,위축형15례,결혈형37례,가관절형5례.골불련병정:6～25개월,평균12.5개월.입원전수술차수:1차42례,2차17례,3차1례.입원전고정방식:강판고정45례,수내정고정8례,외고정지가고정7례.술중균채용자체가골개량결구식골,병응용쇄정강판교접내고정.술후수방환자,기록환자골유합시간급병발증발생정황등. 결과 60례환자술후획6 ～ 24개월(평균12.8개월)수방.59례골불련환자우술후4～8개월(평균5.3개월)획유합；1례고골간골불련환자술후6개월출현강판단렬,입원재차행식골,병재식골구부가1괴중건강판가강고정,6개월후완전유합.소유환자균무감염、기형、쌍하지불등장、취골구동통등병발증발생. 결론 자체가골개량결구식골능구최대정도지발휘식골괴적성골효응,사식골괴신속성활,종이체도치유사지골불련적목적.
Objective To observe the efficacy of treating extremity nonunions by modified autologous iliac grafting.Methods Included in this study were 60 patients who had been treated for extremity nonunion in our department between May 2010 and May 2011.They were 45 men and 15 women,with an average age of 39.2 years (range,13 to 68 years).There were 7 humeral nonunions,19 tibial nonunions,27 femoral nonunions,4 radial nonunions,and 3 clavicle nonunions; by Weber classification,there were 3 hypertrophic nonunions,15 atrophic nonunions,37 ischemic nonunions and 5 pseudarthroses.The mean disease course of nonunion was 12.5 months (from 6 to 25 months).Before this revision,42 patients had one operation,17 had 2 operations and one patient had 3 operations; 45 patients had been treated with plate,8 with intramedullary nail and 7 with external fixator.This revision was performed using modified autologous iliac grafting followed by bridging fixation with locking plate.All patients were followed to document fracture healing and complications.Results The average follow-up was 12.8 months (range,6 to 24 months).The secondary revision led to bone union in 59 cases after a mean time of 5.3 months (range,4 to 8 months).One case of femoral nonunion suffered plate breakage 6 months postoperation which had to be revised by re-grafting and reconstruction plating augmented in the grafting area.No complications like infection,deformity,leg length discrepancy and pain at the bone donating area occurred in this series.Conclusion The modified autologous iliac grafting is highly efficient in curing extremity nonunions,because it can greatly activate the bone graft and increase the conductive and osteoinductive capabilities of the bone graft.