经皮植骨和切开植骨治疗胫骨干骨折术后骨延迟愈合和骨不连

摘要

目的 比较经皮植骨和切开植骨治疗胫骨干骨折延迟愈合及骨不连的效果.方法 37例胫骨干骨折延迟愈合和骨不连患者随机分成两组,19例行经皮植骨,18例行切开植骨,两组植骨量相同.结果 与切开植骨比较,经皮植骨失血量减少,手术时间短(P<0.05).并发症:经皮植骨组1例术后胫前神经麻痹,6周后完全恢复;切开植骨组2例术后33周仍不愈合,48周出现内固定钢板松动,再次髓内钉结合植骨治疗.愈合率和骨愈合时间两组之间差异无统计学意义(P>0.05).结论 在促进胫骨干骨愈合方面,经皮植骨与切开植骨比较效果相似,可作为切开植骨的替代.%Objective To compare the results between percutaneous bone grafting and open hone grafting of tibial shaft fractures delayed union or nonumon.Methods 37 cases of tibial fractured shafts delayed union or nonumon were randomized to either percutaneous bone graft ( n = 19 ) or open bone graft ( n = 18 ).Characteristics of the patients were similar in both groups.Results Percutaneous hone graft technique was associated with significantly less blood loss and shorter operative time ( P ＜ 0.05 ).One patient in the percutaneous group had posterior tibial nerve palsy postoperatively, which recovered completely after 6 weeks.Tow patient in the open bone grafting of tibial shaft fractures are still ununited after 33 weeks.and internal fixation plate loosened after 48 weeks, tibial nail treatment was used with bone grafting again.There were no differences in rate of union, healing time of the successful cases( P ＞0.05 ).Conclusions The percutaneous technique has effective results similar to the open technique in promoting union of tibial fractures.It should be considered as a useful alternative to the open bone graft technique.