目的 分析骨折术后无菌性骨不连的病因,探讨骨皮质剥离术联合植骨与非植骨及辅助固定在无菌性骨不连治疗中的作用.方法 总结2010年1月～ 2016年9月收治的18例无菌性骨不连患者,男性12例,女性6例,年龄17 ～ 64岁,平均36. 8岁;骨不连分类:肥大性7例,萎缩性11例;所有患者均应用骨皮质剥离术,5例内固定断裂更换内固定,13例增加辅助钢板增加稳定性,11例萎缩性骨不连进行自体骨移植.结果 随访6 ～ 18个月,平均随访11个月.患者术后骨折均愈合,未出现术后内固定物断裂,骨愈合的时间4 ～ 10个月,平均愈合时间为6个月.结论 医源性因素是内固定术后无菌性骨不连的重要原因,骨皮质剥离术是治疗无菌性骨不连的有效方法.%Objective To investigate the cause of fracture non-union and discuss the role of combining osteoperiosteal decortication with bone autografting or not and with augmentative internal fixation in the management of aseptic non-union. Methods Retrospective analysis was performed from Jan 2010 to Sep 2016 in 18 patients of osteoperiosteal decortication for aseptic non-union. The non-unions included 7 hypertrophic non-unions and 11 atrophic ones. There were 6 women and 12 men with a mean age of 36. 8 years (range, 17 ～ 64). All procedures were performed by one surgeon using osteoperiosteal decortication. Among these, 5 cases whose broken implant were changed with new fixation, and 13 cases were treated with augmentative plate fixation, and 11 cases of atrophic non-unions were performed with bone autografting. Results All patients were followed up for a mean of 11 months (range 3 ～ 18) without subsequent operations. The bone union time for all the fractures averaged 6months (range 4 ～ 10), with no complications like internal fixation fracture. Conclusion Iatrogenic facture is an important cause for aseptic non-union after reduction and internal fixation of long bone fractures, and osteoperiosteal decortication remains a highly effective surgical technique in the management of failed fracture union.
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