自体髂骨嵌入式植骨和桥接钢板置入固定治疗尺骨远端缺损性萎缩性骨不连21例

摘要

BACKGROUND:Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE:To investigate the outcome of autologous lilac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN,TIME AND SETTING:The own control study was performed at the Department of Orthopaedics,Sixth People's Hospital,Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS:Of 21 cases of the ununited distal ulnar fracture with osseous defects,13 cases were induced by ulnar and radial fracture,and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fracture of first onset. Bone defects were 1.5 cm-5.0 cm,averagely 3.1 cm. METHODS:Bone defects were filled with intercalary lilac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate,reconstruction plate or locking compression plate. At least two screws were used at the distal end,and 3 or 4 screws were fixed in the proximal end,FoUow-up was conducted once per month to observe clinical appearances and radiograph in each patient. MAIN OUTCOME MEASURES:Fracture nonunion,dorsal extension and palmer flexion of wrist joint,pronation and supination of the forearm were measured. RESULTS:All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union,and a mean time of 4.6 months (ranged 3 to 7 months). The distal ulnar healed with < 10° of angular deformity in a coronal plane in one patient and with 15° of angulation in a sagittal plane in another one,while others (19 patients) obtained satisfactory alignment. The excellent and good rate was 90.5％. CONCLUSION:Intercalary bone-grafting with autologous lilac and secure fixation for treating the ununited distal ulnar fracture with osseous defects can reconstruct ulnar length,correct deformities,and obtain good bone healing and functional recovery.%背景:坚强的固定和骨折部位充足的血供是治疗骨不连的基本保证.目的:观察自体髂骨植骨和桥接钢板置入固定治疗尺骨远端缺损性骨不连的疗效.设计、时间及地点:自身对照观察,于2002-08/2006-05在上海交通大学附属第六人民医院骨科完成.对象:入选尺骨远端缺损性骨不连21例,其中尺桡骨双骨折引起的骨不连13例,单纯尺骨骨折引起的骨不连8例.首次发病开放性骨折15例,闭合性骨折6例.骨缺损1.5～5.0 cm,平均3.1 cm.方法:应用嵌入式髂骨植骨,填充骨缺损处.同时控制尺骨的长度和轴线,用5～8孔1/3管形钢板、重建钢板或锁定钢板桥接固定,最远端至少固定2枚螺钉,近端3枚或4枚螺钉.固定后每个月随访1次,观察临床表现和X射线片.主要观察指标:骨折愈合情况,测量其腕关节背伸和掌屈活动度,前臂旋前和旋后活动度.结果:21例患者平均随访14.7个月.所有患者均获骨性愈合,愈合时间3～7个月,平均4.6个月.19例对位对线良好,1例冠状面成角<10°,另1例矢状面成角15°,优良率90.5%.结论:自体髂骨嵌入式植骨和钢板桥接固定治疗尺骨远端缺损性骨不连,能够重建尺骨长度,矫正畸形,取得良好的骨愈合和功能恢复.