Abstract：
OBJECTIVE: To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.
METHODS: A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.
RESULTS: All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).
CONCLUSIONS: On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.
METHODS: A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.
RESULTS: All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).
CONCLUSIONS: On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.
摘要：
目的：探讨在保留原有髓内钉的基础上加装锁定钢板植骨治疗下肢长骨干骨折髓内钉固定术后骨不连的临床效果。
方法：对2015年6月至2020年6月20例下肢长骨干骨折髓内钉固定术后骨折不愈合患者进行回顾性研究。所有患者均采用原始髓内钉和髂骨植骨治疗，并对陈旧性骨折行切开复位钢板内固定和植骨。其中,14人是男性，6人是女性，年龄35～56岁,平均(42.2±9.6)岁。股骨干骨折9例，胫骨干骨折11例。根据骨折端不愈合的特点，6例患者为稳定/萎缩性,9例患者不稳定/大，5例患者不稳定/萎缩性。术后骨不连时间8～12个月,平均(9.8±2.0)个月。视觉模拟量表(VAS)膝盖的运动范围，骨愈合时间，在随访前和最新随访时记录并发症和骨折端愈合情况.
结果：所有患者均获随访18～48个月，平均(36.3±10.5)个月。所有患者的切口均在Ⅰ期愈合，无感染或内固定破裂等并发症。股骨和胫骨愈合时间分别为(8.5±2.6)个月和(9.5±2.2)个月。膝关节活动度由术前(101.05±8.98)°增加至术后(139.35±8.78)°(t=-12.845,P<0.001)。术后随访时VAS评分由术前(5.15±1.72)下降至术后(0.75±0.96)(t=11.186,P<0.001)。
结论：在保留原始髓内钉的基础上，加锁定钢板内固定和自体髂骨植骨具有操作简单的优点,更少的创伤，并发症少,骨折愈合率高。是治疗下肢长骨骨折髓内钉固定术后骨不连的有效手术方案之一。
方法：对2015年6月至2020年6月20例下肢长骨干骨折髓内钉固定术后骨折不愈合患者进行回顾性研究。所有患者均采用原始髓内钉和髂骨植骨治疗，并对陈旧性骨折行切开复位钢板内固定和植骨。其中,14人是男性，6人是女性，年龄35～56岁,平均(42.2±9.6)岁。股骨干骨折9例，胫骨干骨折11例。根据骨折端不愈合的特点，6例患者为稳定/萎缩性,9例患者不稳定/大，5例患者不稳定/萎缩性。术后骨不连时间8～12个月,平均(9.8±2.0)个月。视觉模拟量表(VAS)膝盖的运动范围，骨愈合时间，在随访前和最新随访时记录并发症和骨折端愈合情况.
结果：所有患者均获随访18～48个月，平均(36.3±10.5)个月。所有患者的切口均在Ⅰ期愈合，无感染或内固定破裂等并发症。股骨和胫骨愈合时间分别为(8.5±2.6)个月和(9.5±2.2)个月。膝关节活动度由术前(101.05±8.98)°增加至术后(139.35±8.78)°(t=-12.845,P<0.001)。术后随访时VAS评分由术前(5.15±1.72)下降至术后(0.75±0.96)(t=11.186,P<0.001)。
结论：在保留原始髓内钉的基础上，加锁定钢板内固定和自体髂骨植骨具有操作简单的优点,更少的创伤，并发症少,骨折愈合率高。是治疗下肢长骨骨折髓内钉固定术后骨不连的有效手术方案之一。
