附加钢板单侧植骨治疗股骨干骨折髓内针固定术后肥大性骨不连的临床研究-外科学专业论文.docxVIP

山西医科大学硕士学位论文 山西医科大学硕士学位论文 附加钢板单侧植骨治疗股骨干骨折髓内针固定术后肥大性 骨不连的临床研究 摘 要 目的： 探讨附加钢板单侧植骨治疗股骨干骨折髓内针固定术后肥大性骨不连的植骨必 要性及临床疗效。 方法： 2007 年 7 月到 2012 年 7 月，我科收治股骨干骨折髓内针固定术后肥大性骨不连 患者 23 例，失访 3 例，入选 20 例，其中男性 12 例，女性 8 例，年龄 28 岁-54 岁（平 均 41.6 岁）。骨折不愈合时间为股骨髓内针内固定术后 9-28 月，平均 17.5 个月。入 选病例均采用保留原髓内针，附加锁定加压钢板一侧单皮质固定联合自体髂骨植骨治 疗。术后 7 天开始部分负重，6 个月后完全负重。术后 1、3、6、12 个月临床与影像 学随诊。 结果： 20 例患者术后全部获得随访，随访时间 12-48 个月（平均 33.3 个月）。20 例患 者骨折均获愈合，5 例患者出现供骨区疼痛，1 个月内症状缓解，无感染、内固定松 动、断裂等并发症。骨折断端术后 7 个月出现明显骨痂，植骨侧骨痂出现时间平均 7 个月，非植骨侧骨痂出现时间平均 7.8 个月，9-16 个月愈合牢固，平均愈合时间 12.4 个月。植骨侧与非植骨侧骨痂出现时间差异无统计学意义（Z=-1.302, P=0.1930.05）。 结论： 保留原髓内针，单侧附加钢板治疗股骨干骨折髓针内固定术后肥大性骨不连疗效 确切，无需植骨，具有方法简单、损伤小、手术时间短、出血少、术后活动早等优点， I 是髓针内固定术后肥大性骨不连的有效治疗方法之一。 关键词：股骨骨折；骨折固定术；骨不连；髓内 II PAGE PAGE III Clinical study of augmentative plate fixation combined with one side bone graft for the treatment of femoral hypertrophic nonunion subsequent to intramedullary nailing fixtion Abstract Objective: To investigate the necessity of bone graft and the effect of augmentative plate fixation combined with one side bone graft for the treatment of femoral hypertrophic nonunion subsequent to intramedullary nailing fixtion. Methods: 23 cases with femoral hypertrophic nonunions after intramedullary nail internal fixation were treated with augmentative plate fixation from July 2007 to July 2012,lost 3 cases,20 cases were selected,included 12 males and 8 females with a mean age of 41.6 years(ranged from 28 to 54 years). The mean period of nonunions after surgery was 17.5 months(ranged from 9 to 28 months). All patients applied with augmentative plate ,retained the original intramedullary nail,and combined with one side auto-ilial bone graft. 7 days after the operation ,patients were allowed to partial weight-bearing until full weight-bearing in 6 months after operation.All patients were fullowed up and were evaluated with clinical and imaging results in 1,3,6,12 months after operation. Results: All patients were fullowed up from 12-48 months,averaged 33.3 months.