摘要
目的探讨锁定加压钢板联合自体髂骨移植治疗胫骨骨折髓内钉术后萎缩性骨不连的效果。方法选取2014-04—2016-11间沧州中西医结合医院收治的27例胫骨骨折髓内钉内固定术后萎缩性骨不连患者,均实施锁定加压钢板联合自体髂骨移植手术。术后对患者进行临床和影像学随访。结果全部患者切口均I期愈合。X线复查骨不连均获骨性愈合,愈合时间16~24周,平均18.7周。随访期间未发生感染及内固定松动、断裂等并发症。结论锁定加压钢板联合自体髂骨移植治疗胫骨髓内钉术后萎缩性骨不连,能增加骨不连局部稳定性和成骨能力,有利于骨不连愈合,效果满意。
Objective To investigate the clinical therapeutic effect of locking compression plate combined with autologous iliac bone graft for treating atrophic nonunion of tibial following intramedullary nail. Methods A retrospective analysis from April 2014 to November2016,27 patients with atrophic nonunion after tibial fracture with intramedullary nail underwent limited contact locking compression plate and autologous iliac bone graft in our hospital. All patients were followed up and evaluated with clinical and radiographic results. Results All patients were followed up over 8 months and surgical incision were healed by first intention. X-ray examination showed all patients achieved bony union within 16-24 weeks,an average of 18. 7 weeks,and there were no complications to be noted such as infection and internal fixation loosing after operations. Conclusion Atrophic titial nonunions can be successfully treated with locking compression plate combined with autologous iliac bone graft by increasing titial stability and osteogenic capacity,and the clinical effects are satisfactory.
引文
[1]Tzioupis C,Giannoudis PV.Prevalence of long-bone non-unions[J].Injury,2007,38:S3-S9.
[2]Brinker MR,Hanus BD,Sen M,et al.The devastating effects of tibial nonunion on health-related quality of life[J].J Bone Joint Surg Am,2013,18,95(24):2170-2176.
[3]周正震,陈辉文,常思灵,等.胫骨骨不连的研究进展[J].河北医药,2017,39(6,)930-932.
[4]魏均强,张伯勋,陈华,等.萎缩性骨折不愈合的研究新进展[J].中国骨伤,2012,25(12),1053-1056.
[5]Rupp M,Biehl C,Budak M,et al.Diaphyseal long bone nonunionstypes,aetiology,economics,and treatment recommendations[J].Int Orthop,2018,42(2):247-258.
[6]Willis MP,Brooks JP,Badman BL,et al.Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft[J].J Orthop Trauma,2013,27(2):77-81.
[7]Sen MK,Miclau T.Autologous iliac crest bone graft:should it still be the gold standard for treating nonunions?[J].Injury,2007,38:S75-80.
[8]Weiland AJ,Phillips TW,Randolph MA.Bone grafts:a radiologic,histologic,and biomechanical model comparing autografts,allografts,and free vascularized bone grafts[J].Plast Reconstr Surg,1984,74(3):368-379.
[9]Ueng SW,Chao EK,Lee SS,et al.Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing[J].J Trauma,1997,43(4):640-644.
[10]Oh JK,Bae JH,Oh CW,et al.Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft[J].Injury,2008,39(8):952-959.
