外固定支架加压牵开再加压治疗长管状骨非感染性不愈合

第一作者:滕星

2011-06-01 点击量:1615   我要说

滕星,黄雷,杨胜松,赵刚,王满宜 

摘要:目的 探讨不进行植骨,单纯通过外固定支架进行加压-牵开-再加压的方法治疗长管状骨非感染性不愈合的疗效.方法 2007年3月至2009年7月对5例长管状骨(4例股骨,1例胫腓骨)非感染性不愈合患者,通过带延长装置的单边外固定支架,先对不愈合端加压并维持2周,然后以1 mm/d的速度(每天分4次进行)逐渐牵开10~14 mm,维持2周后再以1 mm/d的速度(每天分4次进行)进行短缩,直到骨不愈合端加压.通过X线评价骨不愈合端的成骨情况,若成骨反应活跃,则维持加压直至愈合;若成骨反应差,则重复上述过程1~2个周期,直至愈合.结果 1例胫腓骨不愈合患者出现针道深部感染、松动并导致对位异常,给予全身抗生素应用,经过3个周期的加压-牵开-再加压后骨折愈合.1例股骨干不愈合患者在第2次加压时出现内翻、向后成角.另3例患者只出现针道并发症.经过相应治疗,5例患者均达到骨性愈合,平均愈合时间为7.6个月(6~10个月),平均带架时间为12.2个月(6~17个月),拆除外固定支架后平均随访5.8个月(1~10个月),无再骨折发生.结论 对于不合并肢体长度异常、有良好接触面积、骨折端形态适合加压的长管状骨非感染性不愈合,通过单纯应用外固定架固定并依次加压、牵开再加压可使骨折愈合,且减少了术中出血和对不愈合端的剥离,避免了植骨.
 
Abstract:Objective To treat noninfectious nonunion of tubular fractures with compres-sion-distraction-compression technique by external fixators without grafting. Methods Form March 2007 to July 2009, 5 cases of noninfectious nonunion (involving 4 femurs and one tibiofibula) were stabilized by external fixators with a distraction device. Nonunians were compressed for 2 weeks, followed by distraction of one mm per day divided by 4 times until. A separation of 10 to 14 mm was achieved. The maximal distraction was maintained for 2 weeks before shortening with the same speed and rhythm was performed until the second com-pression. Next the nonunion site was compressed till union if osteogenic activity was present radiographically. One or two more cycles of compression-distractian were needed until union in cases of poor osteogenie response. Results Pin-tract infection and loosening happened in the tibiofibular nonunion and led to malapposition. Varns and reeurvatum deformities were present in a femoral nonunion at the time of the second compression. No other complications were noticed in other cases except pin tract problems. All 5 nonunions healed with an average healing time of 7.6 (6 to 10) months. Follow-ups for an average of 5.8 (1 to 10) months after fixator removal revealed no refracture. Conclusions Compression-distraction with external fixator is useful for noninfectious nonunions of tubular fractures. It can also decrease hemorrhage and soft tissue stripping during operation because it does not necessitate grafting. This technique may be indicated for those with no obvious leg length discrepancy, good contact area and optimal configuration for efficient compression.

 

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