下肢骨干骨折髓内钉术后非感染性骨不连的原因分析及临床疗效观察
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摘要
目的探讨下肢骨干骨折髓内钉术后非感染性骨不连的原因,并观察扩髓保留髓内钉联合附加侧板用于骨不连的临床疗效。方法选取2010年5月—2016年8月中江县人民医院收治的下肢骨干骨折髓内钉固定术后非感染性骨不连患者86例,随机分成对照组与研究组,各43例。对照组运用更换髓内钉治疗,研究组采用扩髓保留髓内钉联合附加侧板治疗,比较分析两组临床疗效。结果研究组患者的手术时间、术中出血量、术中输悬浮红细胞量均低于对照组,差异有统计学意义(P<0.01);研究组与对照组术后引流量与住院时间比较,差异无统计学意义(P>0.05)。两组患者切口均属于Ⅰ期愈合,无血管与神经损伤等发生。治疗后,两组患者未出现感染、畸形愈合与患肢功能障碍等并发症。两组随访时间为12~24个月,平均16.5个月。两组患者骨折均愈合,其中研究组患者的临床骨愈合时间与影像学骨愈合时间短于对照组,差异有统计学意义(P<0.01)。末次随访研究组临床疗效优良率高于对照组,差异有统计学意义(P<0.05)。结论扩髓保留髓内钉联合附加侧板治疗下肢骨干骨折髓内钉术后非感染性骨不连的效果优于更换髓内钉,此法操作简单、手术时间短、临床效果显著,是治疗非感染性骨不连的首选方法。
Objective To analyze the causes for aseptic shaft nonunion of the lower extremities after intramedullary nailing and to observe the therapeutic effects on bone nonunion by the combined technique of intramedullary nail retention with augmentation plating. Methods 86 cases of aseptic shaft nonunion of the lower extremities after intramedullary nailing patients were selected from Deyang County People's Hospital from May 2010 to August 2016. All patients were randomly divided into the control group( n = 43) and the study group( n = 43). The control group were treated with intramedullary nail retention with augmentation plating, the study group were treated with intramedullary nail exchanging, and the therapeutic effects were compared and analyzed. Results The operation time,blood loss,volume for suspended red blood cells transfusion in the study group were lower than that in the control group( P < 0. 01). There was no significant difference in postoperative drainage volume and hospitalization days between two group( P > 0. 05). All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 16. 5 months on average( range,12-24 months). During follow-up,no following complication occurred in both group: infection,malunion and limb dysfunction. All cases obtained bone union,and time of clinical and radiological bone healing in the study group was significantly shorter than those in the control group( P <0. 01). At the end of the follow-up,the excellent and good rate of the study group was higher than that in the control group,the differences were statistically significant( P < 0. 05). Conclusion Intramedullary nail retention with augmentation plating is an the optimal method for aseptic shaft nonunion of the lower extremities after intramedullary nailing and can achieve satisfactory clinical outcomes because it has simpler operation,shorter operation time.
Objective To analyze the causes for aseptic shaft nonunion of the lower extremities after intramedullary nailing and to observe the therapeutic effects on bone nonunion by the combined technique of intramedullary nail retention with augmentation plating. Methods 86 cases of aseptic shaft nonunion of the lower extremities after intramedullary nailing patients were selected from Deyang County People's Hospital from May 2010 to August 2016. All patients were randomly divided into the control group( n = 43) and the study group( n = 43). The control group were treated with intramedullary nail retention with augmentation plating, the study group were treated with intramedullary nail exchanging, and the therapeutic effects were compared and analyzed. Results The operation time,blood loss,volume for suspended red blood cells transfusion in the study group were lower than that in the control group( P < 0. 01). There was no significant difference in postoperative drainage volume and hospitalization days between two group( P > 0. 05). All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 16. 5 months on average( range,12-24 months). During follow-up,no following complication occurred in both group: infection,malunion and limb dysfunction. All cases obtained bone union,and time of clinical and radiological bone healing in the study group was significantly shorter than those in the control group( P <0. 01). At the end of the follow-up,the excellent and good rate of the study group was higher than that in the control group,the differences were statistically significant( P < 0. 05). Conclusion Intramedullary nail retention with augmentation plating is an the optimal method for aseptic shaft nonunion of the lower extremities after intramedullary nailing and can achieve satisfactory clinical outcomes because it has simpler operation,shorter operation time.
引文
[1]郑金文,刘显东,王小兵,等.下肢骨干骨折术后骨不连的原因分析及手术治疗[J].中国骨与关节损伤杂志,2014,29(12):1236-1238.
[2]WESTACOTT D,BOULD M.Outcome in 36 elderly patients treated with the Gamma3 Long Nail for unstable proximal femoral fracture[J].Acta Orthop Belg,2011,77(1):68-72.
[3]PARK K,KIM K,CHOI Y S,et al.Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nailusing cadaveric fracture model of the femur[J].Int Orthop,2011,35(4):581-585.
[4]王拴柱,尚建军,祝成社,等.股骨干骨折髓内钉固定后非感染性骨不连的原因分析及治疗[J].实用骨科杂志,2015,21(6):500-505.
[5]LIN C J,CHIANG C C,WU P K,et al.Effectiveness of plate augmentation for femoral shaft nonunion after nailing[J].J Chin Med Assoc,2012,75(8):396-401.
[6]CHEN C M,SU Y P,HUNG S H,et al.Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture[J].Orthopedics,2010,33(6):393.
[7]TAITSMAN L A,LYNCH J R,AGEL J,et al.Risk factors for femoral nonunion after femoral shaft fracture[J].J Trauma,2009,67(6):1389-1392.
[8]李冀,赵伟超,关鹏飞,等.长骨医源性骨不连的临床流行病学调查[J].中国骨与关节损伤杂志,2012,27(1):34-36.
[9]王飞达,高耀祖,卫小春.股骨干骨折髓内钉固定术后无菌性骨不连的治疗进展[J].中国矫形外科杂志,2014,22(18):1675-1677.
[10]毛玉江,武长江,孙林,等.股骨干骨折钢板内固定失效更换髓内钉固定的改良手术方法[J].中华创伤骨科杂志,2012,14(11):964-967.
[11]茹江英,仓海滨,胡传亮,等.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效比较[J].中国修复重建外科杂志,2013,27(1):25-27.
[12]魏俊强,刘利蕊,潘进社,等.仰卧位与侧卧位闭合复位髓内钉内固定治疗股骨干骨折的疗效比较[J].中华创伤骨科杂志,2013,15(8):660-665.
[13]茹江英,仓海斌,胡玉华,等.保留髓内钉附加侧板治疗股骨干非峡部段骨不连[J].中国组织工程研究,2013,17(39):6932-6939.
[14]茹江英,仓海滨,胡传亮,等.附加侧板联合植骨治疗股骨干骨折髓内钉固定后骨不连[J].中国组织工程研究,2013,17(4):604-611.
[2]WESTACOTT D,BOULD M.Outcome in 36 elderly patients treated with the Gamma3 Long Nail for unstable proximal femoral fracture[J].Acta Orthop Belg,2011,77(1):68-72.
[3]PARK K,KIM K,CHOI Y S,et al.Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nailusing cadaveric fracture model of the femur[J].Int Orthop,2011,35(4):581-585.
[4]王拴柱,尚建军,祝成社,等.股骨干骨折髓内钉固定后非感染性骨不连的原因分析及治疗[J].实用骨科杂志,2015,21(6):500-505.
[5]LIN C J,CHIANG C C,WU P K,et al.Effectiveness of plate augmentation for femoral shaft nonunion after nailing[J].J Chin Med Assoc,2012,75(8):396-401.
[6]CHEN C M,SU Y P,HUNG S H,et al.Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture[J].Orthopedics,2010,33(6):393.
[7]TAITSMAN L A,LYNCH J R,AGEL J,et al.Risk factors for femoral nonunion after femoral shaft fracture[J].J Trauma,2009,67(6):1389-1392.
[8]李冀,赵伟超,关鹏飞,等.长骨医源性骨不连的临床流行病学调查[J].中国骨与关节损伤杂志,2012,27(1):34-36.
[9]王飞达,高耀祖,卫小春.股骨干骨折髓内钉固定术后无菌性骨不连的治疗进展[J].中国矫形外科杂志,2014,22(18):1675-1677.
[10]毛玉江,武长江,孙林,等.股骨干骨折钢板内固定失效更换髓内钉固定的改良手术方法[J].中华创伤骨科杂志,2012,14(11):964-967.
[11]茹江英,仓海滨,胡传亮,等.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效比较[J].中国修复重建外科杂志,2013,27(1):25-27.
[12]魏俊强,刘利蕊,潘进社,等.仰卧位与侧卧位闭合复位髓内钉内固定治疗股骨干骨折的疗效比较[J].中华创伤骨科杂志,2013,15(8):660-665.
[13]茹江英,仓海斌,胡玉华,等.保留髓内钉附加侧板治疗股骨干非峡部段骨不连[J].中国组织工程研究,2013,17(39):6932-6939.
[14]茹江英,仓海滨,胡传亮,等.附加侧板联合植骨治疗股骨干骨折髓内钉固定后骨不连[J].中国组织工程研究,2013,17(4):604-611.