附加钢板技术治疗股骨远端骨折外侧钢板内固定术后骨不连的适应症和应用原则

doi:10.13418/j.issn.1001-165x.2017.05.018

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (5): 567-570.doi: 10.13418/j.issn.1001-165x.2017.05.018

附加钢板技术治疗股骨远端骨折外侧钢板内固定术后骨不连的适应症和应用原则

李海峰¹，　顾三军¹，　殷渠东¹，　孙振中¹，　吴永伟¹，　芮永军¹，　胡辉东²

1.无锡市第九人民医院骨科，江苏无锡 214062；　2.常州市第四人民医院骨科，江苏常州 213000

收稿日期:2017-01-07 出版日期:2017-09-25 发布日期:2017-10-30
通讯作者: 殷渠东，主任医师，E-mail: wxswyw@126.com
作者简介:李海峰（1980-），男，江苏无锡人，主治医师，硕士，主要从事骨科关节、关节镜和创伤治疗，Tel：（0510）85867999，E-mail：13665150065@163.com

Augmentation plating technique in the treatment of nonunion of distal femoral fractures after lateral plating

LI Hai-feng¹, GU San-jun¹, YIN Qu-dong¹, SUN Zhen-zhong¹, WU Yong-wei¹, RUI Yong-jun¹, HU Hui-dong²

1. Department of Orthopaedics,Wuxi NO.9 People’s Hospital,Jiangsu 214062,China; 2. Department of Orthopaedics, Changzhou NO.4 People’s Hospital,Jiangsu 213000,China

Received:2017-01-07 Online:2017-09-25 Published:2017-10-30

摘要/Abstract

摘要：

目的　总结应用附加钢板技术治疗股骨远端骨折外侧钢板内固定术后骨不连的适应症、应用原则和效果。方法　对30例股骨远端骨折外侧钢板内固定术后非感染性骨不连应用附加钢板技术治疗。均为萎缩型骨不连。通过内侧小切口行重建钢板内固定，同时自体髂骨植骨。术后早期康复活动。记录骨愈合和并发症情况，比较术前、术后随访膝关节活动范围，按Schatzker-Lambert股骨远端骨折功能评分评价患肢功能恢复。结果　切口均I期愈合。获12~32个月、平均16.3个月随访。骨折均愈合，愈合时间3~6个月，平均4.6个月。无感染和神经血管损伤，无钢板松动和断裂。末次随访，膝关节活动范围(100.10±23.31)°，较术前（55.29±23.01)°明显改善（t=-13.112，P=0.000），患肢功能恢复优9例、良16例、可3例、差2例（优良率83.33%）。结论　附加钢板技术适合股骨远端粉碎骨折外侧钢板内固定术后无内固定失效的非感染性骨不连，按相应原则应用，具有手术创伤小、术后可早期康复、骨愈合率和功能恢复满意率均较高等特点。

关键词: 股骨远端骨折, 　内固定, 　骨不连, 　附加钢板技术

Abstract:

Objective　To summarize the indications, mechanism and efficacy of augmentation plating technique in the treatment of nonunion of distal femoral fractures after lateral plating.　Methods　30 cases of non-infective nonunion of distal femoral fractures after lateral plating were treated with augmentation plating technique. All were atrophic nonunion. A reconstruction plate was used by a small medial incision and iliac autogenous bone graft was performed. Early rehabilitation was taken postoperatively. The healing time and complications were recorded; comparison of the range of movement of knee between pre-op and post-op at follow-up was made, and the functional recovery of the affected limb by Schatzker-Lambert score system was evaluated.　Results　All incisions healed by first intention. All patients were followed up for 32 to 12 months with an average of 16.3 months. All fractures healed within 3 to 6 months, with an average of 4.6 months. No infection and injury of nerve and vessel, no loosening or breaking of plate and screw were noted. At the last follow-up, the range of movement of knee (100.10±23.31)° was significantly improved compared to that of the preoperative（55.29±23.01)°（t=-4.911，P=0.000）; the functional recovery of the affected limb was excellent in 9 cases, good in 16 cases, fair in 3 cases and poor in 2 cases (the excellent and good rate was 83.33%).　Conclusion　 Augmentation plating technique is indicated for aseptic nonunion of distal femoral comminuted fractures after lateral plating without loosening or breaking of internal fixation, which has characteristics of less trauma, early rehabilitation, high rates of healing and satisfactory of functional recovery as long as performed according to its principles.

Key words: Distal femoral fracture, 　Internal fixation, 　Nonunion, 　Augmentation plating technique

李海峰,顾三军,殷渠东,孙振中,吴永伟,芮永军,胡辉东. 附加钢板技术治疗股骨远端骨折外侧钢板内固定术后骨不连的适应症和应用原则[J]. 中国临床解剖学杂志, 2017, 35(5): 567-570.

LI Hai-feng, GU San-jun, YIN Qu-dong, SUN Zhen-zhong, WU Yong-wei, RUI Yong-jun, HU Hui-dong. Augmentation plating technique in the treatment of nonunion of distal femoral fractures after lateral plating[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(5): 567-570.

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附加钢板技术治疗股骨远端骨折外侧钢板内固定术后骨不连的适应症和应用原则

Augmentation plating technique in the treatment of nonunion of distal femoral fractures after lateral plating

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