CAJ | 학술논문

目的探讨断端成骨能力区域划分对锁定钢板桥接技术联合植骨治疗骨不连的临床意义. 方法回顾性分析2012年1月至2013年9月收治的138例骨不连患者资料,男102例,女36例;年龄12 ～ 73岁,平均38.6岁.骨不连部位:肱骨干20例,胫腓骨45例,股骨干73例(股骨近端25例和股骨中下段骨48例).骨不连分型:萎缩型42例,缺血型86例,假关节型10例.术中将骨不连断端分为成骨失活区(瘢痕组织、硬化死骨组织)及成骨活跃区(正常骨痂形成组织),植骨范围完全跨越成骨失活区,桥接成骨活跃区.所有患者均采用锁定钢板桥接技术联合植骨治疗,如植骨块＞ 2cm,植骨块前侧附加重建接骨板固定.术后记录骨不连愈合时间及并发症情况,并采用相应评分标准评定各部位术后功能. 结果所有患者术后获6 ～ 24个月(平均12.4个月)随访.134例患者骨不连于术后5～10个月(平均6.3个月)获愈合.20例肱骨干骨不连患者Constant评分平均为91.2分,Mayo肘关节功能评分平均为90.7分;45例胫腓骨骨不连患者采用美国膝关节协会评分(AKSS)评定膝关节功能优良率为100％,Kofoed评分评定踝关节功能优良率为93.3％ (42/45);25例股骨近端骨不连和48例股骨中下段骨不连患者分别采用Sanders评分和AKSS评分评定疗效,优良率分别为96.0％ (24/25)和95.8％(46/48).所有患者均无感染、双下肢不等长、取骨区疼痛等并发症发生. 结论成骨活跃区与成骨失活区之间存在明显的成骨差异,采用锁定钢板桥接技术联合自体骨植骨治疗时,植骨块应完全跨越成骨失活区,可最大程度发挥成骨效应.
목적 탐토단단성골능력구역화분대쇄정강판교접기술연합식골치료골불련적림상의의. 방법 회고성분석2012년1월지2013년9월수치적138례골불련환자자료,남102례,녀36례;년령12 ～ 73세,평균38.6세.골불련부위:굉골간20례,경비골45례,고골간73례(고골근단25례화고골중하단골48례).골불련분형:위축형42례,결혈형86례,가관절형10례.술중장골불련단단분위성골실활구(반흔조직、경화사골조직)급성골활약구(정상골가형성조직),식골범위완전과월성골실활구,교접성골활약구.소유환자균채용쇄정강판교접기술연합식골치료,여식골괴＞ 2cm,식골괴전측부가중건접골판고정.술후기록골불련유합시간급병발증정황,병채용상응평분표준평정각부위술후공능. 결과 소유환자술후획6 ～ 24개월(평균12.4개월)수방.134례환자골불련우술후5～10개월(평균6.3개월)획유합.20례굉골간골불련환자Constant평분평균위91.2분,Mayo주관절공능평분평균위90.7분;45례경비골골불련환자채용미국슬관절협회평분(AKSS)평정슬관절공능우량솔위100％,Kofoed평분평정과관절공능우량솔위93.3％ (42/45);25례고골근단골불련화48례고골중하단골불련환자분별채용Sanders평분화AKSS평분평정료효,우량솔분별위96.0％ (24/25)화95.8％(46/48).소유환자균무감염、쌍하지불등장、취골구동통등병발증발생. 결론 성골활약구여성골실활구지간존재명현적성골차이,채용쇄정강판교접기술연합자체골식골치료시,식골괴응완전과월성골실활구,가최대정도발휘성골효응.
Objective To explore the feasibility and clinical value of determining zones of different osteogenesis capabilities at the fracture ends for bone grafting to treat bone nonunion.Methods Between January 2012 and September 2013,138 patients with nonunion were treated in our department.They were 102 men and 36 women,12 to 73 years of age (38.6 years on average).The bone nonunion was located at the humeral shaft in 20 cases,the tibiofibula in 45,and the femoral shaft in 73.The nonunion was of atrophic type in 42 cases,of ischemic type in 86,and of pseudarthrosis type in 10.Intraoperatively,the fracture ends were determined as one osteogenesis deactivation zone (scar tissue and hardened sequestrum) and 2 osteogenesis activation zones (normal porosis tissue).Bone grafting was conducted across the osteogenesis deactivation zone to bridge the osteogenesis activation zones.All patients were fixated by locking compression plate.When the graft size ＞ 2 cm,a reconstruction plate was added on the anterior of the graft.The time for nonunion healing and complications were recorded.The postoperative function was assessed according to corresponding criteria.Results The average follow-up time was 12.4 months (from 6 to 24 months).Bone union was achieved in 134 cases after an average of 6.3 months (from 5 to 10 months).For the 20 cases of humeral shaft nonunion,the average Constant score was 91.2 points and the average Mayo elbow performance score 90.7 points; for the 45 cases of tibiofibular nonunion,the excellent to good rate of knee function was 100％ by American Knee Society Score and the excellent to good rate of ankle function 93.3％ (42/45) by Kofoed evaluation system; for the 73 cases of femoral shaft nonunion,the excellent to good rate of the hip was 96.0％ (24/25) by the Sanders evaluation system and 95.8％ (46/48) by the American Knee Society Score.No such complications occurred as infection,bilateral leg length discrepancy,or pain at the bone donation area.Conclusion Since the bone deactivation and activation zones have significantly different osteogenesis capabilities,autologous bone grafting should span the deactivation zone to bridge the activation zones to take the most advantage of active osteogenesis when it is used in combination with locking plate to cure bone nonunion.