阻挡钉治疗胫骨干骨折髓内钉术后肥大性骨不连△

Blocking screws for hypertrophic nonunion secondary to intramedullary nailing of tibial shaft fracture

摘要:

［目的］ 探讨阻挡钉治疗胫骨干骨折交锁髓内钉术后肥大性骨不连的临床疗效。［方法］ 回顾性分析 2014 年 1 月— 2019 年 12 月采用阻挡钉治疗的胫骨干骨折交锁髓内钉术后肥大性骨不连 34 例患者的临床资料。其中，男 15 例，女 19 例； 平均年龄 （39.55±10.85） 岁；均为闭合性骨折，AO 分型：A 型 12 例，B 型 17 例，C 型 5 例。总结阻挡钉治疗临床与影像资料。［结果］ 所有患者均顺利完成手术，术中无血管、神经损伤等严重并发症，手术时间 （41.18±11.53） min、切口长度 （2.09±0.79） cm、术中出血量 （4.58±2.36） ml、术中透视 （4.32±1.25） 次。患者术后均获随访 （20.21±6.26） 个月，术后随时间推移，VAS 评分逐渐减小，膝关节 HSS 评分、踝关节 AOFAS 评分显著增加（P<0.05）。其中有 31 例术后骨折愈合，愈合时间 （5.71±1.40） 个月，3 例骨折未愈合，予更换直径更大髓内钉及植骨后痊愈。［结论］ 应用阻挡钉治疗胫骨干骨折交锁髓内钉术后肥大性骨不连是一种微创、安全、高效的手术方式。

Abstract:

[Objective] To investigate the clinical outcomes of blocking screws for hypertrophic nonunion secondary to interlocking in- tramedullary nailing of tibial shaft fracture. [Methods] A retrospective study was done on 34 patients who underwent additional blocking screws for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture from January 2014 to December 2019. Of them, 15 males and 19 females aged (39.55±10.85) years on average, and suffered closed AO type A in 12 cases, type B in 17 cas- es and type C in 5 cases. The clinical and imaging data of additional blocking screw therapy were summarized. [Results] All the patients were successfully operated on without any serious complications, such as vascular and nerve injury, whereas with operative time of (41.18± 11.53) min, the incision length of (2.09±0.79) cm, intraoperative blood loss of (4.58±2.36) ml, and the intraoperative fluoroscopy of (4.32± 1.25) times. As time went during the follow-up period lasted for (20.21±6.26) months, the VAS score significantly decreased, whereas the knee HSS score and ankle AOFAS score increased significantly (P＜0.05) . All patients got nonunion healed in (5.71±1.40) months, except 3 patients were prone to remain fracture nonunion, which finally healed after revision surgery of replacement of a larger diameter intramed- ullary nail and bone grafting. [Conclusion] Additional blocking screw is a minimally invasive, safe and efficient treatment for hypertrophic nonunion secondary to interlocking intramedullary nailing of tibial shaft fracture.