| 改进植骨方式结合锁定加压钢板治疗胫骨中下段骨不连 |
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Received:February 17, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 赵雪 |
ZHAO Xue |
第二军医大学附属长海医院骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China |
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| 王攀峰 |
WANG Pan-feng |
第二军医大学附属长海医院骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China |
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| 章云童 |
ZHANG Yun-tong |
第二军医大学附属长海医院骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China |
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| 张春才 |
ZHANG Chun-cai |
第二军医大学附属长海医院骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China |
zhangchuncai@sina.vip.com |
| 许硕贵 |
XU Shuo-gui |
第二军医大学附属长海医院骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China |
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| 张欣 |
ZHANG Xin |
第二军医大学附属长海医院骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China |
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| 期刊信息：《中国骨伤》2014年27卷，第12期，第1008-1011页 |
| DOI：10.3969/j.issn.1003-0034.2014.12.008 |
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目的: 探讨改进植骨方式结合锁定加压钢板治疗胫骨中下段骨不连的方法.
方法: 自2011年1月至2012年12月,采用改进植骨方式结合锁定加压钢板治疗12例胫骨中下段骨不连患者,其中男8例,女4例;年龄20～69岁,平均47岁.初次外伤至此次骨不连手术时间为9个月～5年,平均1年7个月.伤后行外固定支架治疗4例,钢板内固定治疗6例,髓内钉治疗 2例,其中2例来院时已出现钢板、螺钉断裂.11例为非感染性骨不连,1例为感染性骨不连.术前X线及CT检查提示全部病例有不同程度的死骨、硬化骨形成.术中记录手术时间、出血量,术后观察伤口愈合情况,并根据术后X线片复查情况评价骨愈合时间.术后10个月参照Johner-Wruhs标准对踝关节功能进行评分.
结果: 手术时间90～185 min,平均(125.00±20.15) min;术中出血量225～750 ml,平均(415.00±120.00) ml.12例均获随访,时间10个月～2.5年,平均1.5年.术后复查X线片提示,全部病例4个月内骨断端形成骨桥样骨连接,3例6个月达到类骨板样骨愈合,其余9例术后8～12个月达到类骨板样骨愈合.术后未出现伤口感染,神经、血管损伤,钢板、螺钉断裂等手术并发症.术后10个月根据Johner-Wruhs标准进行踝关节功能评价,优10例,良1例,可1例.
结论: 采用改进植骨方式结合锁定加压钢板,在骨不连断端充分加压的基础上建立骨断端多点支撑,实现有效固定是治疗胫骨中下段骨不连的有效方法. |
| [关键词]:胫骨 骨折 外固定器 骨折愈合 |
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| Advanced bone graft combined with locking compression plate for the treatment of middle and distal tibia nonunion |
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Abstract:
Objective: To explore methods of treating middle and distal tibia nonunion with the treatment of advanced bone graft combined with locking compression plate.
Methods: From January 2011 to December 2012,12 patients with middle and distal tibia nonunion were treated with advanced bone graft combined with locking compression plate. Among patients,there were 8 males and 4 females aged from 20 to 69 with an average of 47 years old. The time from first injuries to bone nonunion was from 9 months to 5 years,avergaed 19 months. Four cases were treated with external fixation,6 cases were treated with plate fixation,2 cases of 12 patients occurred broken of plate and nail. Eleven patients were non-infective bone nonunion and 1 patient was infective bone nonunion. Preoperative X-ray and CT showed all patients had sequestration and formation of ossified bone with different degrees. Operative time,blood loss,wound healing were observed,fracture healing time was evaluated by postoperative X-ray. Johner-Wruhs scoring standards was used to evaluate ankle joint function after operation at 10 months.
Results: Operative time ranged from 90 to 185 min with an average of(125.00±20.15) min; blood loss ranged from 225 to 750 ml with an average of(415.00±120.00) ml. All patients were followed up from 10 months to 2.5 years with an average of 1.5 years. Postoperative X-ray showed bone union was formed around fracture after operation at 4 months in all patients,3 cases obtained bone healing within 6 months after operation,9 cases obtained from 8 to 12 months. No infection,injury of nerve and vessles,and broken of plate and nail were ocurred. According to Johner-Wruhs scoring at 10 months after operation,10 cases obtained excellent results,1 good and 1 moderate.
Conclusion: Advanced bone graft combined with locking compression plate,which can build fracture multi-point supporting based on full compression of bone nonunion to get effective fixation,is an effective method in treating middle and distal tibia nonunion. |
| KEYWORDS:Tibia Fractures External fixtors Fracture healing |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵雪,王攀峰,章云童,张春才,许硕贵,张欣.改进植骨方式结合锁定加压钢板治疗胫骨中下段骨不连[J].中国骨伤,2014,27(12):1008~1011 |
| 英文格式: | ZHAO Xue,WANG Pan-feng,ZHANG Yun-tong,ZHANG Chun-cai,XU Shuo-gui,ZHANG Xin.Advanced bone graft combined with locking compression plate for the treatment of middle and distal tibia nonunion[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(12):1008~1011 |
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