前臂骨干骨折骨不连原因分析及对策.docVIP

前臂骨干骨折骨不连原因分析及对策 　 作者：汪金荣，卢海霖，刘洪，杨新文 【摘要】 目的 探讨前臂骨干骨折骨不连的原因和再治疗对策。方法 回顾分析1996～2006年收治的前臂骨干骨折骨不连27例。其中Judet、Cech分类：Ⅰ型骨不连23例，Ⅱ型骨不连4例。其中单纯桡骨骨折2例，单纯尺骨骨折3例，尺桡骨双骨折4例，Monteggia骨折11例，Galeazzi骨折7例。全部病例采用6～8孔自动加压接骨板(DCP）或限制接触性加压接骨板(LC-DCP）再治疗，其中15例打通髓腔单纯加压内固定或皮质切削断端周围植骨内固定；12例打通髓腔行髓腔内梭形或飞轮状植骨使尺骨或桡骨延长3～11 mm再加压内固定。4例Monteggia骨折尺桡上关节分离大者，同期行环状韧带重建。结果 27例中因内固定物折断、弯曲、松动19例。内固定物失效发生在2～9个月之内，3例为再次受伤者。其余8例为小夹板和石膏固定4～8周者。再治疗后根据前臂疗效评定标准：优15例，良6例，可5例，差1例。优良率77.78%。无内植物折断失用等病例发生。结论 前臂骨干骨折发生骨不连的主要原因是：特殊的解剖关系；治疗方案不妥；内固定物选择不当；骨折粉碎，中间节段手术或非手术的血液循环损伤；固定不牢靠以及功能锻炼不当等多种因素有关，关键是基层医院的医生普遍存在对该部位骨折认识不足。ＤＣＰ或ＬC－ＤＣＰ固定加植骨或不植骨是再治疗中简单实用且经济可靠的方法和对策。如果是Monteggia和Galeazzi骨折骨不愈合以及前臂单股单根骨折骨不愈合，根据术前术中骨缩短的程度，适当的行断端间延长植骨，则可提高手术效果。 【关键词】 前臂骨折；治疗；失败；原因；对策 Reason analysis and countermeasure nonunion and backbone fracture of forearm ［Abstract］ Objective Probe into the reason why the nonunion and backbone of the forearm and treat the countermeasure again.Methods Reviewed and analyzed the nonunion and backbone fracture of the forearm accepted for medical treatment during the decade in 1996～2006 27 cases.Among them Judet，Cech classify :The type Ⅰnonunion was 23，type Ⅱ was 4.2 simple radius fractures were among them，3 simple ulna fractures，4 fractures were ulna-radiuses，11 were Monteggia fractures，7 Galeazzi fractures.All cases adopted 6～8 holes pressure and set a fracture automatically board (DCP） or restrain contacting pressurization from setting a fracture board (LC-DCP） to treat again，15 among them got through marrow fixedly while pressurizing or the cortex cut and broke the end while planting the bone around fixedly;12 streamline marrow of competent marrow shuttle loom shape or flywheel form bone graft made ulna or radius lengthen 3～11 mm fixed pressure.4 Monteggia fracture chies of oar joint separating heavily，rebuilt anular ligament in the same term.Results The fixed thing was broken inside，crooked，became flexible in 19 of 27.The fixed thing lost efficiency and happened within 2～9 months，3 were in wounded agai