【摘要】：目的:探討附加鋼板單側(cè)植骨治療股骨干骨折髓內(nèi)針固定術(shù)后肥大性骨不連的植骨必要性及臨床療效。方法:2007年7月到2012年7月,我科收治股骨干骨折髓內(nèi)針固定術(shù)后肥大性骨不連患者23例,失訪3例,入選20例,其中男性12例,女性8例,年齡28歲-54歲(平均41.6歲)。骨折不愈合時(shí)間為股骨髓內(nèi)針內(nèi)固定術(shù)后9-28月,平均17.5個(gè)月。入選病例均采用保留原髓內(nèi)針,附加鎖定加壓鋼板一側(cè)單皮質(zhì)固定聯(lián)合自體髂骨植骨治療。術(shù)后7天開始部分負(fù)重,6個(gè)月后完全負(fù)重。術(shù)后1、3、6、12個(gè)月臨床與影像學(xué)隨診。結(jié)果:20例患者術(shù)后全部獲得隨訪,隨訪時(shí)間12-48個(gè)月(平均33.3個(gè)月)。20例患者骨折均獲愈合,5例患者出現(xiàn)供骨區(qū)疼痛,1個(gè)月內(nèi)癥狀緩解,無感染、內(nèi)固定松動(dòng)、斷裂等并發(fā)癥。骨折斷端術(shù)后7個(gè)月出現(xiàn)明顯骨痂,植骨側(cè)骨痂出現(xiàn)時(shí)間平均7個(gè)月,非植骨側(cè)骨痂出現(xiàn)時(shí)間平均7.8個(gè)月,9-16個(gè)月愈合牢固,平均愈合時(shí)間12.4個(gè)月。植骨側(cè)與非植骨側(cè)骨痂出現(xiàn)時(shí)間差異無統(tǒng)計(jì)學(xué)意義(Z=-1.302,P=0.1930.05)。結(jié)論:保留原髓內(nèi)針,單側(cè)附加鋼板治療股骨干骨折髓針內(nèi)固定術(shù)后肥大性骨不連療效確切,無需植骨,具有方法簡單、損傷小、手術(shù)時(shí)間短、出血少、術(shù)后活動(dòng)早等優(yōu)點(diǎn),是髓針內(nèi)固定術(shù)后肥大性骨不連的有效治療方法之一。
文內(nèi)圖片：
圖片說明：病例一患者X線片
[Abstract]:Objective: to investigate the necessity and clinical effect of unilateral bone grafting with additional plate in the treatment of hypertrophic nonunion after intramedullary nail fixation. Methods: from July 2007 to July 2012, 23 patients with hypertrophic nonunion were treated in our department. There were 3 patients with hypertrophic nonunion after intramedullary nail fixation. 20 patients, including 12 males and 8 females, aged from 28 to 54 years (mean 41.6 years), were enrolled in the study. The nonunion time of fracture was 9-28 months after internal fixation of bone marrow needle, with an average of 17.5 months. All the selected cases were treated with preservation of the original intramedullary needle, single cortical fixation with locking compression plate and autogenous ilium bone grafting. Partial load began 7 days after operation and completely loaded 6 months later. Clinical and imaging follow-up was performed at 1, 3, 6, 12 months after operation. Results: all the 20 patients were followed up for 12 to 48 months (mean 33. 3 months). All the 20 patients were healed, 5 patients had pain in the donor area, symptoms relieved within 1 month, no infection, loosening of internal fixation, fracture and other complications. There were obvious eschar at 7 months after fracture, 7 months on average, 7.8 months on average, and 12.4 months on average on the non-graft side, and the average healing time was 12.4 months for 9 鈮，

本文編號：2511356