刘志军

[摘要] 目的 研究评价锁定钢板联合自体髂骨植骨治疗四肢长骨干骨折术后无菌性骨不连的临床效果。 方法 选取2006年1月～2013年6月因内固定失败而造成四肢长骨干无菌性骨不连患者43例，均采用锁定钢板固定联合自体髂骨植骨进行治疗。 结果 患者均获得随访，随访时间7～24个月，平均12.6个月。骨不连均愈合，愈合时间为（5.9±1.0）个月。3例（6.9%）出现切口表面感染，经治疗后均痊愈；2例（4.7%）切口延迟愈合；1例（2.3%）出现肢体短缩约2 cm，无一例发生骨折畸形愈合。末次随访时关节活动度较术前显著改善，其中功能优良35例（81.4%），可7例（16.3.%），差1例（2.3%）。 结论 锁定钢板联合自体髂骨植骨治疗四肢长骨干骨折术后无菌性骨不连，具有确切的疗效，锁定钢板联合自体髂骨移植治疗能为骨折提供可靠的内固定稳定性和良好的骨诱导以及骨传导作用，效果良好。

[关键词] 锁定钢板；四肢长骨干骨折；骨折固定术；内固定器；髂骨移植

[中图分类号] R683.4 [文献标识码] B [文章编号] 1674-4721（2014）08（a）-0176-04

Effect observation on locking plate combining with autologous iliac bone graft in the treatment of aseptic nonunion after surgery of long bone fractures of extremities

LIU Zhi-jun

Department of Orthopedics，Shengbei Hospital，Shengli Petroleum Administration of Dongying City in Shandong Province，Dongying 257064，China

[Abstract] Objective To research and evaluate the effect of locking plate combining with autologous iliac bone graft on treating aseptic nonunion after surgery of long bone fractures of extremities. Methods 43 cases of patients with aseptic nonunion on limb long bone caused by bone fixation failure were accepted in our hospital from January 2006 to June 2013.All of patients were treated with locking plate combining with autologous iliac bone graft. Results All patients were followed up.The follow-up time ranged from 7 to 24 months，with an average of 12.6 months.All of nonunion were healed in （5.9±1.0） months.Cut surface infection occurred in 3 cases （6.9%），which were cured after treatment.The slowly healed wound were 2 cases （4.7%） and limb about 2 cm shortened in 1 case （2.3%）.None of cases suffered from malunion.At the final follow-up，joint activity improved more significantly compared with before surgery，including 35 cases （81.4%） with excellent effect，7 cases （16.3%） moderate，and 1 case （2.3%） poor. Conclusion In the treatment of patients with aseptic nonunion after surgery of long bone fractures of extremities，using locking plate for internal fixation is a curative therapy.Locking plate combining with autologous iliac bone graft can provide reliable fixation stability for fractura，and shows good functions on bone induction and conduction，so it obtains a favorable effect.

[Key words] Locking plate；Limb long bone fracture；Fracture fixation；Internal fixation；Iliac bone graft

四肢长骨干骨折发生率较高，是临床中常见的骨折，目前已经普遍应用各种内固定材料进行治疗。大多数骨折在预期时间内能够愈合，而少数骨折因为术后感染、螺钉断裂、钢板断裂、髓内钉断裂、内固定材料变形等原因而在预期时间内仍不能愈合而导致骨不连[1-3]。无菌性骨不连是四肢骨折治疗过程中比较常见而又比较严重的并发症之一[4]。因此，骨不连的治疗被认为是骨折处理中最大的挑战之一[5]。骨不连的患者一旦确诊，应该尽可能快地进行再次手术治疗。通过更换内固定材料，如更换髓内钉或者钢板，或者选用其他适宜的内固定材料治疗而获得骨愈合的成功率在40%～100%[4，6-9]。本研究采用锁定加压钢板治疗因内固定失败而造成的无菌性骨不连43例，探讨其临床疗效。endprint