优化穿针组合式外固定架治疗股骨远端骨不连的临床疗效
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摘要
背景:骨不连是股骨远端骨折术后严重并发症,其发生率高,如何在内固定失效时尽可能小的创伤处理骨不连是创伤外科医师面临的一项难题。目的:评价优化穿针布局的组合式外固定技术治疗股骨远端骨折术后骨不连的临床疗效。方法:回顾性分析2010年5月至2016年12月间收治的采用优化穿针的组合式外固定架固定治疗的股骨远端骨折术后骨不连患者21例。13例行自体髂骨移植,8例行断端骨皮质剥脱术。采用X线检查评估骨折愈合,记录并对比术前与随访终末期膝关节活动度(ROM),终末随访时采用美国特种外科医院(HSS)评分评估膝关节功能。结果:所有患者术后随访10～26个月,平均随访(16.5±2.8)个月。21例患者均获得牢固骨性愈合,平均带架时间(9.3±1.6)个月,未见畸形愈合、感染,1例拆除外固定架后1个月发生再骨折。终末随访时膝关节ROM较术前有不同程度的改变,膝关节功能优良率为66.7%(14/21)。结论:采用优化穿针组合式外固定架治疗股骨远端骨不连的愈合率高,是一种安全、创伤小且简单易行的方法。但应注意膝关节最大屈曲度减少等并发症。
Background:Nonunion is a serious postoperative complication of distal femoral fractures and has a high incidence.How to minimize the invasive treatment of nonunion after internal fixation failure is a difficult problem for trauma surgeons.Objective:To evaluate the clinical effect of combined external fixation for the nonunion of distal femoral fractures by optimizing the placement of needle-pinning.Methods:Retrospective analysis was made in 21 patients with combined external fixation for distal femoral nonunion from May 2010 to December 2016.Autogenous iliac bone grafting was performed 13 patients,and cortices were stripped on the broken end of fractured bone.X-ray examination was used to evaluate fracture healing.Range of motion(ROM)of the knee were recorded before surgery and at the last follow-up.The Hospital for Special Surgery(HSS)score was used to rank the function of knee joint at the last follow-up.Results:The mean duration of follow-up was(16.5±2.8)months(range,10-26 months)in all the patients.Solid bone healing was achieved in all the patients.The mean retention time of frame was(9.3±1.6)months.No malunion or infection was found.Refracture occurred in one patient one month later after removing the external fixator.The excellent and good rate of knee joint function was 66.7%(14/21)at the last follow-up.Conclusions:It is a safe,minimally invasive and simple method to treat the nonunion of the distal femur by the combined external fixator with optimized needle-pinning.But pay attention to complications such as reduced maximum knee flexion.
Background:Nonunion is a serious postoperative complication of distal femoral fractures and has a high incidence.How to minimize the invasive treatment of nonunion after internal fixation failure is a difficult problem for trauma surgeons.Objective:To evaluate the clinical effect of combined external fixation for the nonunion of distal femoral fractures by optimizing the placement of needle-pinning.Methods:Retrospective analysis was made in 21 patients with combined external fixation for distal femoral nonunion from May 2010 to December 2016.Autogenous iliac bone grafting was performed 13 patients,and cortices were stripped on the broken end of fractured bone.X-ray examination was used to evaluate fracture healing.Range of motion(ROM)of the knee were recorded before surgery and at the last follow-up.The Hospital for Special Surgery(HSS)score was used to rank the function of knee joint at the last follow-up.Results:The mean duration of follow-up was(16.5±2.8)months(range,10-26 months)in all the patients.Solid bone healing was achieved in all the patients.The mean retention time of frame was(9.3±1.6)months.No malunion or infection was found.Refracture occurred in one patient one month later after removing the external fixator.The excellent and good rate of knee joint function was 66.7%(14/21)at the last follow-up.Conclusions:It is a safe,minimally invasive and simple method to treat the nonunion of the distal femur by the combined external fixator with optimized needle-pinning.But pay attention to complications such as reduced maximum knee flexion.
引文
[1]Koso RE,Terhoeve C,Steen RG,et al.Healing,nonunion,and re-operation after internal fixation of diaphyseal and distal femoral fractures:a systematic review and meta-analysis.Int Orthop,2018,42(11):2675-2683.
[2]康庆林,张长青,柴益民编译.Ilizarov技术基本原理及应用.北京:人民军医出版社,2012:90-97.
[3]郑欣,郭开今,庞勇,等.双钢板固定联合开槽植骨治疗股骨远端难治性骨不连的疗效分析.实用骨科杂志,2017,23(3):276-279.
[4]杨冬松,王亮,甄相周,等.经髌骨下小切口逆行髓内钉内固定加植骨治疗股骨远端骨折不愈合的疗效观察.中国骨与关节损伤杂志,2016,31(10):1086-1087.
[5]陈楚鹰,何久盛,张永林.附加接骨板联合自体植骨治疗下肢长骨髓内钉术后不愈合.中华骨与关节外科杂志,2016,9(2):149-152.
[6]Kloen P,Doty SB,Gordon E,et al.Expression and activation of the BMP-signaling components in human fracture nonunions.J Bone Joint Surg,2002,84(11):1909-1918.
[7]Hutson JJ.Invited commentary related to:treatment options for nonunion with segmantal bone defects:systematic review and quantitiative evidence synthesis.J Orthop Trauma,2017,31(2):119-120.
[8]Basbozkurt M,Kurklu M,Yurttas Y,et al.Ilizarov external fixation without removal of plate or screws:effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure.J Orthop Trauma,2012,26(8):e123-e128.
[9]Hosny GA,Ahmed AA,Hussein MA.Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones nonunion.Int Orthop,2018,42(12):2933-2939.
[10]Ma CH,Chiu YC,Tu YK,et al.Three-stage treatment protocol for recalcitrant distal femoral nonunion.Arch Orthop Trauma Surg,2017,137(4):489-498.
[11]马显志,韩生寿,马骏,等.股骨干骨折术后骨折不愈合的治疗进展.中华骨与关节外科杂志,2018,11(5):390-394,400.
[12]康庆林,陆联松,陈栋,等.Ilizarov外固定器治疗肥大性骨不连.中华骨科杂志,2012,32(3):217-221.
[13]Kabata T,Tsuchiya H,Sakurakichi K,et al.Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss.J Trauma,2005,58(6):1213-1222.
[14]焦绍锋,秦泗河,王振军,等.Ilizarov技术治疗四肢畸形并发症分析.中华骨科杂志,2012,32(3):245-248.
[15]夏和桃,张晓林.组合式外固定器的研制与临床应用.中华创伤杂志,1992,8(5):263-265.
[16]张俊忠,李振阳,张鹏,等.定量外固定器刚度对骨折愈合影响的组织学研究.中国中医骨伤科杂志,2018,26(1):5-9.
[17]艾合买提江·玉苏甫.骨延长治疗近期关注热点.中国修复重建外科杂志,2018,32(7):849-853.
[18]夏和桃,秦泗河,李刚.现代骨外固定理念与原则.中国矫形外科杂志,2013,21(10):955-956.
[2]康庆林,张长青,柴益民编译.Ilizarov技术基本原理及应用.北京:人民军医出版社,2012:90-97.
[3]郑欣,郭开今,庞勇,等.双钢板固定联合开槽植骨治疗股骨远端难治性骨不连的疗效分析.实用骨科杂志,2017,23(3):276-279.
[4]杨冬松,王亮,甄相周,等.经髌骨下小切口逆行髓内钉内固定加植骨治疗股骨远端骨折不愈合的疗效观察.中国骨与关节损伤杂志,2016,31(10):1086-1087.
[5]陈楚鹰,何久盛,张永林.附加接骨板联合自体植骨治疗下肢长骨髓内钉术后不愈合.中华骨与关节外科杂志,2016,9(2):149-152.
[6]Kloen P,Doty SB,Gordon E,et al.Expression and activation of the BMP-signaling components in human fracture nonunions.J Bone Joint Surg,2002,84(11):1909-1918.
[7]Hutson JJ.Invited commentary related to:treatment options for nonunion with segmantal bone defects:systematic review and quantitiative evidence synthesis.J Orthop Trauma,2017,31(2):119-120.
[8]Basbozkurt M,Kurklu M,Yurttas Y,et al.Ilizarov external fixation without removal of plate or screws:effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure.J Orthop Trauma,2012,26(8):e123-e128.
[9]Hosny GA,Ahmed AA,Hussein MA.Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones nonunion.Int Orthop,2018,42(12):2933-2939.
[10]Ma CH,Chiu YC,Tu YK,et al.Three-stage treatment protocol for recalcitrant distal femoral nonunion.Arch Orthop Trauma Surg,2017,137(4):489-498.
[11]马显志,韩生寿,马骏,等.股骨干骨折术后骨折不愈合的治疗进展.中华骨与关节外科杂志,2018,11(5):390-394,400.
[12]康庆林,陆联松,陈栋,等.Ilizarov外固定器治疗肥大性骨不连.中华骨科杂志,2012,32(3):217-221.
[13]Kabata T,Tsuchiya H,Sakurakichi K,et al.Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss.J Trauma,2005,58(6):1213-1222.
[14]焦绍锋,秦泗河,王振军,等.Ilizarov技术治疗四肢畸形并发症分析.中华骨科杂志,2012,32(3):245-248.
[15]夏和桃,张晓林.组合式外固定器的研制与临床应用.中华创伤杂志,1992,8(5):263-265.
[16]张俊忠,李振阳,张鹏,等.定量外固定器刚度对骨折愈合影响的组织学研究.中国中医骨伤科杂志,2018,26(1):5-9.
[17]艾合买提江·玉苏甫.骨延长治疗近期关注热点.中国修复重建外科杂志,2018,32(7):849-853.
[18]夏和桃,秦泗河,李刚.现代骨外固定理念与原则.中国矫形外科杂志,2013,21(10):955-956.
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