附加钢板治疗髓内钉新固定后股骨萎缩性骨不连.doc

附加钢板治疗髓内钉固定后股骨萎缩性骨不连 张建政 刘智 孙天胜 郭永智 李京生 任继鑫 胥少汀 [摘要] 目的 探讨附加钢板治疗髓内钉固定后股骨萎缩性骨不连的手术适应证和操作技术。方法1999年6月-2009年6月，应用附加钢板合并开放植骨治疗12例髓内钉固定后股骨萎缩性骨不连。小切口微创清除骨折端肉芽组织，硬化骨去皮质化，足量髂骨纵形平铺于骨不连间隙和骨皮质骨床上， 选择5～6孔钛合金限制接触型动力接骨板，3.0 mm克氏针钻孔，4～6枚皮质骨螺钉双皮质固定。术后保护性负重，1，3，6，12个月临床与影像学评估。 结果 全部获得骨性愈合，随访时间7～26个月(平均17.4个月)，取髂骨植骨并附加钢板固定手术时间共50～120 min（平均77.5 min），出血量150～350 ml(平均252 ml)。术后供骨区疼痛9例，7例1个月内缓解，2例3个月后缓解。临床骨性愈合时间5～9个月（平均7.1个月）；影像学愈合时间7～12个月（平均9.4个月）；无感染、钢板螺钉松动、断裂等。结论 附加钢板合并植骨适用于髓内钉固定后股骨干骺端骨不连、AO分型B型骨折骨不连、骨缺损＞1cm以及扩髓更换髓内钉失败的萎缩性骨不连。 【关键词】 萎缩性；股骨；骨折固定，髓内；钢板 Augmentative plate fixation to treat femoral atrophic nonunions subsequent to intramedullary nailing ZHANG Jian-zheng, LlU Zhi, SUN Tian-sheng, et at. Department of Orthopaedics, General Hospital of Beijing Military Command, Beijing 100700, China [Abstract] Objective To investigate the indications and technical aspects of augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008, which were managed with a nail internal fixation. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all cases during operation. Leaving the intramedullary nail in situ, enough autogenous iliac crest bone graft and an augmentative plate fixation were applied to the fracture site. A general plate with at least four screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of the bone shaft. The motion disappeared after plate augmentation in all patients. Results All patients achieved radiological solid union and clinic union at an average of 9.4 months (range, 7 to 12 months )and 7.1 months (range, 5 to 9 months ) respectively. No infection, hardware loo