对腓骨骨板植骨治疗陈旧性骨折骨不连的再认识_临床医学论文.docVIP

对腓骨骨板植骨治疗陈旧性骨折骨不连的再认识_临床医学论文 对腓骨骨板植骨治疗陈旧性骨折骨不连的再认识_临床医学论文 作者：朱大成，王丽，张强，高健伟， 陈君生，刘学义 【摘要】 ［目的］对自体腓骨骨板移植单独或联合钢板内固定治疗长骨干陈旧性骨折不连接的临床研究和探讨，评价腓骨骨板植骨治疗陈旧性骨折骨不连的价值。［方法］四肢长骨干骨折不愈合57 例，男41 例，女16 例；年龄20～56 岁，平均41.6 岁。其中合并短缩畸形18 例，平均短缩2.6 cm，成角畸形12 例；平均成角15°。骨不连时间平均6个月～3年。去除骨不连的两断段硬化骨质，切取适当长度的游离腓骨骨板，用螺丝钉或钢板内固定。［结果］随访时间平均3年（1～6年），手术后1、3、6、12、24个月X线片检查，57例患者骨折全部愈合，平均时间15周（8～24周）。行走或负重等功能良好，无1例发生不愈合。［结论］自体腓骨骨板移植单独或联合钢板内固定治疗长骨干骨折不愈合，可加速骨折愈合，早期功能恢复，仍是治疗四肢长骨干骨折不愈合的理想方法。 【关键词】 四肢长骨骨折； 不愈合； 骨移植； 腓骨板 Abstract：［Objective］To discuss the technique and outcome in the treatment of old nonunion of long bone fracture by using autologous fibula plate alone or combination with internal fixator plates.［Method］Fifty-seven patients(41 males and 16 females; average age of 41.6 years ) with nonunion of long bone fracture were recruited. Of them 18 had short deformity(average 2.6 cm) and 12 had angled deformity(average 15°) . Average time was 12 months (6-36 months). The sclerosed cortex was removed at both ends of the nonunion long bone. A suitable length of fibula plate were transplanted by screw with or without internal fixator plates.［Result］The follow-up average time was 3 years (ranged, 1 to 6 years) . At 1, 3, 6, 12, 24 months after operation, the outcome was analyzed by radiography. Bone healing was found in all 57 patients, with an average of 15 weeks (8-24 weeks). All the patients exhibited a good function in walking and burdening. No nonunion occurred. ［Conclusion］Autologous fibula plate with or without internal fixator plates for nonunion of long bone fracture can facilitate healing and early functional recovery. This therapeutic method is an ideal technique in treating patients with nonunion of long bone fracture. Key words：long bone fracture; nonunion; bone transplantation; fibula plate 随着我国交通事业的发展，车辆的增加，意外灾害事故导致的外伤骨折越来越多，特别是四肢长骨干骨折中，多段骨折、粉碎骨折、开放性骨折的发生率日渐增多。由于骨短缩、缺损治疗困难，术后发生骨不连的病例也更为常见。据资料统计,美国每年发生约600万骨折患者中, 5%～10%发生骨折延迟愈合或骨不连。骨不连延长了患者的病残时间,对生活质量影响极大,同时治疗难度更大，是临床医生棘手的难题。上世纪60年代国内外即有