LCP结合腓骨、髂骨植骨治疗股骨干骨不愈合
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摘要
目的探讨股骨干骨折术后不愈合及肢体短缩的治疗方法。方法选择2011年2月-2017年10月股骨干骨折不愈合40例,均有不同程度的肢体短缩,按随机数字表分为观察组和对照组,每组20例。观察组采用髓内腓骨植骨,骨折断端髂骨植骨,股骨干锁骨加压钢板(locking compression plate, LCP)内固定;对照组采用髓内钉固定。两组术后均早期行功能训练。结果术后随访10～36个月,平均23个月,骨折愈合时间3～18个月,平均7个月,观察组19例均达到骨折愈合及恢复肢体长度的目的,患肢功能恢复良好,内固定无断裂等并发症发生。6周后有骨痂生长,功能训练时骨折断端疼痛缓解,3～5个月骨痂明显增多,可扶拐负重行走锻炼,平均6～8个月骨折愈合,膝关节屈伸功能正常。对照组骨折临床愈合8例,膝关节功能恢复6例,肢体长度恢复仅10例,治疗效果比较观察组明显优于对照组(P <0.05)。结论采用LCP联合腓骨+髂骨植骨,是治疗股骨干骨折不愈合及肢体短缩的可靠方法。
Objective To discuss the treatment of nonunion and limb shortening after femoral shaft fracture. Methods From February 2011 to October 2017, 40 cases of nonunion of femoral fracture patients who have different degrees of limb shortening, were divided into experiment group and control group with every 20 patients agroup, according to random number table. The experiment group used intramedullary fibular bone graft, iliac bone graft at fracture end, LCP internal fixation and the control group used intramedullary nail. After surgery, both of them were treated with early postoperative functional exercise. Results All cases were followed up for 10～36 months, average of 23 months. The fracture was united from 3 to 18 months after operation, average 7 months, in the experiment group, all19 patients achieved fracture healing and restored the limb length well, there were no internal fixation fracture and other complications. The callus growed 6 weeks after the operation, fracture broken end's pain relieved when doing the functional exercise, callus increased significantly 3～5 months later and patients could do walking exercise with crutches and loads, the extension and flexion function was restored to normal at 6～8 months when the fracture healed. In the control group, there were 8 cases of clinical healing, 6 cases of knee joint function recovery, and only 10 cases of limb length recovery. The experimental group was significantly better than the control group in the treatment effect(P <0.05).Conclusion LCP combined with fibula and iliac bone graft is a reliable method for treatment of nonunion and shortening of femoral fractures.
Objective To discuss the treatment of nonunion and limb shortening after femoral shaft fracture. Methods From February 2011 to October 2017, 40 cases of nonunion of femoral fracture patients who have different degrees of limb shortening, were divided into experiment group and control group with every 20 patients agroup, according to random number table. The experiment group used intramedullary fibular bone graft, iliac bone graft at fracture end, LCP internal fixation and the control group used intramedullary nail. After surgery, both of them were treated with early postoperative functional exercise. Results All cases were followed up for 10～36 months, average of 23 months. The fracture was united from 3 to 18 months after operation, average 7 months, in the experiment group, all19 patients achieved fracture healing and restored the limb length well, there were no internal fixation fracture and other complications. The callus growed 6 weeks after the operation, fracture broken end's pain relieved when doing the functional exercise, callus increased significantly 3～5 months later and patients could do walking exercise with crutches and loads, the extension and flexion function was restored to normal at 6～8 months when the fracture healed. In the control group, there were 8 cases of clinical healing, 6 cases of knee joint function recovery, and only 10 cases of limb length recovery. The experimental group was significantly better than the control group in the treatment effect(P <0.05).Conclusion LCP combined with fibula and iliac bone graft is a reliable method for treatment of nonunion and shortening of femoral fractures.
引文
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[10]Arpacioglu MO,Akmaz I,Mahirogullari M,et al.Treatment of femoralshaft fractures by interlocking intramedullary nailing in adults[J].Acta Orthop Traumatol Turc,2003,37(3):203-212.
[11]Yamaji T,Ando K,Nakamura T,et al.Femoral shaft fracture callus formation after intramedullary nailing:a comparison of interlocking and Ender nailing[J].Orthop Sci,2002,7(4):472-476.
[12]Jain AK,Sinha S.Infected nonun ion of the long bones[J].Clin Orthop Relat Res,2005,(431):57-65.
[13]Court-brown CM,Keating JF.Exchange intramedullary nailing[M].Bone Joint Surg(Br),1995,77:407-411.
[14]Lu Yong-hui,Dong Wei-qiang,Bai Bo.Use of An Intramedullary Interlocking Nail for Treatment of Femoral Non-union[J].Academic Journal of Guangzhou Mediccollege,2004,(3):55-57.
[15]Hak DJ,Lee SS,Goulet JA.Success of exchange reamed in-tramedullary nailing for femoral shaft nonunionor delayed union[J].J Orthop Trauma,2000,14(3):178-182.
[16]Im GI,Shin SR.Treatment of femoral shaft fractures with a ti-tanium intramedullary nail[M].Clin Orthop,2002.401,223-229.
[17]刘佰弘,林治建,徐军,等.植骨术在股骨骨不连中的临床应用[J].中医正骨,2010,22(8):367-368.
[18]Han Hua.Comparison of Therapeutic Effect of Locking Intramedullary Nail and Locking Plate in Treatment of Femoral Fractures in Adults[J].Mod Diagn Treat,2015,(17):3862-3864.
[19]Wang Yonghua.Treatment of Nonunion of Femoral Shaft Fracture with Inter Locked Intramedullary Nail Assisted by Side Plate and Autologous Bone Graft[J].Inner Mongolia Med,2012,(12):1447-1448.
[20]张志海.钢板与髓内钉治疗成年人股骨干骨折临床分析[D].大连医科大学硕士论文.2013.
[21]Chen Wu Lin,Wei Li Ping,Ding Xing Po,et al.Clinical Analysis of 15 Cases of Nonunionand Delayed Union of Femur Shaft Frac-ture Treatedby Interlocking Intramedullary Nail Combined with Small Plate[J].World Journal of Integrated Traditional and Western Medicine,2010,(1):74-75.
[2]Insall Jn,Dorr LD,Scott RD,et al.Rational of the knee society clinical rating system[J].Clin Orthop,1989,24(8):13-14.
[3]张宁,董桂贤,李煜,等.带锁髓内钉辅以锁定钢板加植骨治疗股骨干骨折钢板固定术后骨不连[J].临床骨科杂志,2012,15(5):530-532.
[4]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第3版.北京:人民军医出版社,2005.723.
[5]千明哲.探讨锁定加压钢板和植骨方法治疗尺骨干骨折骨不连的临床应用价值[J].中国继续医学教育,2015,7(7):37-38.
[6]Court-brown CM,Keating j F.Exchange intramedullary nailing[M].Bone Joint Surg(Br),1995,77:407-411.
[7]Runkel M,Pseudoarthrosis.Pseudoparthrosis[J].Unfallchirurg,2000,103(1):51-63
[8]Jain AK,Infectednonunionofthelongbones[J].Infected nonunion of the long bones[J].Clin Orthop Relat Res,2005,(431):57-65.
[9]Bauer TW.Bone graft materials Anoverview of the basic science[J].Clin Orthop,2000,37(1):10-27.
[10]Arpacioglu MO,Akmaz I,Mahirogullari M,et al.Treatment of femoralshaft fractures by interlocking intramedullary nailing in adults[J].Acta Orthop Traumatol Turc,2003,37(3):203-212.
[11]Yamaji T,Ando K,Nakamura T,et al.Femoral shaft fracture callus formation after intramedullary nailing:a comparison of interlocking and Ender nailing[J].Orthop Sci,2002,7(4):472-476.
[12]Jain AK,Sinha S.Infected nonun ion of the long bones[J].Clin Orthop Relat Res,2005,(431):57-65.
[13]Court-brown CM,Keating JF.Exchange intramedullary nailing[M].Bone Joint Surg(Br),1995,77:407-411.
[14]Lu Yong-hui,Dong Wei-qiang,Bai Bo.Use of An Intramedullary Interlocking Nail for Treatment of Femoral Non-union[J].Academic Journal of Guangzhou Mediccollege,2004,(3):55-57.
[15]Hak DJ,Lee SS,Goulet JA.Success of exchange reamed in-tramedullary nailing for femoral shaft nonunionor delayed union[J].J Orthop Trauma,2000,14(3):178-182.
[16]Im GI,Shin SR.Treatment of femoral shaft fractures with a ti-tanium intramedullary nail[M].Clin Orthop,2002.401,223-229.
[17]刘佰弘,林治建,徐军,等.植骨术在股骨骨不连中的临床应用[J].中医正骨,2010,22(8):367-368.
[18]Han Hua.Comparison of Therapeutic Effect of Locking Intramedullary Nail and Locking Plate in Treatment of Femoral Fractures in Adults[J].Mod Diagn Treat,2015,(17):3862-3864.
[19]Wang Yonghua.Treatment of Nonunion of Femoral Shaft Fracture with Inter Locked Intramedullary Nail Assisted by Side Plate and Autologous Bone Graft[J].Inner Mongolia Med,2012,(12):1447-1448.
[20]张志海.钢板与髓内钉治疗成年人股骨干骨折临床分析[D].大连医科大学硕士论文.2013.
[21]Chen Wu Lin,Wei Li Ping,Ding Xing Po,et al.Clinical Analysis of 15 Cases of Nonunionand Delayed Union of Femur Shaft Frac-ture Treatedby Interlocking Intramedullary Nail Combined with Small Plate[J].World Journal of Integrated Traditional and Western Medicine,2010,(1):74-75.