胫骨骨折术后骨不连治疗方法的疗效比较Comparison of therapeutic methods in postoperative non-union of tibial fracture
韦敏克;梁斌;尹东;李宏宇;
摘要(Abstract)：
[目的]探讨带锁髓内钉固定后胫骨骨折骨不连治疗方法的选择和疗效。[方法]348例带锁髓内钉固定胫骨骨折中发生骨不连36例。采用冲击波治疗10例;髓内钉动力化8例;髓内钉动力化加自体植骨6例;单纯自体植骨5例;改钢板固定加自体植骨3例;肥大型骨不连更换髓内钉4例。[结果]所有病例平均随访28个月。6个月内再手术者较6个月后再手术者愈合时间明显缩短(P<0.05)。冲击波治疗10例中1例不愈合,经2次冲击波治疗后愈合。髓内钉动力化8例中2例不愈合,经冲击波治疗后愈合,其中2例发生骨缩短;髓内钉动力化加自体植骨6例均愈合;单纯自体植骨5例中2例8个月未愈合,更换髓内钉加自体植骨后愈合;改钢板固定加自体植骨3例均愈合;肥大型骨不连更换髓内钉4例均愈合。[结论]早期治疗带锁髓内钉固定后胫骨骨折骨不连效果肯定。髓内钉动力化可促进骨愈合,但有引起骨缩短的可能;更换髓内钉或钢板加自体植骨治疗骨不连效果满意;冲击波有促进骨不连愈合的作用。
关键词(KeyWords)： 胫骨骨折;术后;带锁髓内钉;骨不连;骨折固定术
基金项目(Foundation): 广西壮族自治区科技厅科学基金资助项目(No.0342024)
作者(Author): 韦敏克;梁斌;尹东;李宏宇;
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DOI:
参考文献(References)：
- [1]Webb LX.Bone defect nonunion of thc lower extremity[J].Ortho-paed,2001,16:387-397.
- [2]Pihlajamaki HK,Salminen ST,Bostman OM.The treatment of non-unions following intramedullary nailing of femoral shaft fractures[J].J Orthop Trauma,2002,16:392-402.
- [3]Canadian Orthopaedic Trauma Society.Nonunion following intramed-ullary nailing of the femur with and without reaming:results of a mu-litcenter randomized clinical trial[J].J Bone Joint Surg(Am),2003,85:2093-2096.
- [4]张亚非,庞桂根,张涛,等.髓内钉治疗胫腓骨骨折适应范围及疗效探讨[J].中国矫形外科杂志,2006,14:1693-1696.
- [5]王根林,杨惠林,牛国旗,等.交锁髓内钉治疗胫骨骨折并发症分析[J].中国矫形外科杂志,2006,14:1681-1683.
- [6]Weresh MJ,Hakanson R,Stover MD,et al.Failure of exchangereamed intramedullay nails for ununited femoral shaft fractures[J].JOrthop Trauma,2000,14:335-338.
- [7]Yu CW,Wu CC,Chen WJ.Aseptic nonunion of a femoral shaft trea-ted using exchange nailing[J].Chang Gung Med J,2002,25:591-598.
- [8]Menon DK,Dougall TW,Pool RD,et al.Augmentative Ilizarov exter-nal fixation after failure of diaphyseal union with intramedullary nail-ing[J].J Orthop Trauma,2002,16:491-497.
- [9]梁斌,李宏宇,李丽春,等.体外冲击波刺激成骨作用对骨不连间隙的影响[J].中国临床康复,2005,9(38):92-94.