Wu C C
Department of Orthopedics, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Chang Gung Med J. 2000 Jun;23(6):319-30.
A fracture nonunion is not uncommon and the principle of treatment has been well established. Traditionally, for the efficacy of treatment, a nonunion is classified as a hypervascular (hypertrophic) or an avascular (atrophic) type. Methods for treating nonunion are multiple and bone grafting techniques have been the most convincing and widely used. Bone grafts can be divided into allografts and autografts and cortical or cancellous bone grafts; each has its individual function. However, both types of a nonunion need to be supplemented with cancellous bone graft to increase the rate of success. Basically, effective treatment should include making fracture gaps vanish, providing sufficient stability, and initiating osteogenic power. Clinically, use of the closed bone grafting technique is preferable when possible. However, the critical size for using the closed technique to treat segmental bony defects has yet to be defined, and the open technique should be utilized whenever the effectiveness of the closed technique is in doubt. To simplify the surgical procedure and to reduce morbidity at the donor site, bone graft substitutes should be continuously investigated.
骨折不愈合并不少见，其治疗原则已得到充分确立。传统上，为了评估治疗效果，骨折不愈合被分为高血运（肥大性）或无血运（萎缩性）类型。治疗骨折不愈合的方法多种多样，而骨移植技术一直是最具说服力且应用最广泛的。骨移植可分为同种异体骨移植和自体骨移植，以及皮质骨或松质骨移植；每种都有其独特的作用。然而，两种类型的骨折不愈合都需要补充松质骨移植以提高成功率。基本上，有效的治疗应包括消除骨折间隙、提供足够的稳定性以及激发成骨能力。临床上，尽可能优先使用闭合性骨移植技术。然而，使用闭合技术治疗节段性骨缺损的临界尺寸尚未明确，每当对闭合技术的有效性存疑时，就应采用开放性技术。为了简化手术过程并降低供区的发病率，应持续研究骨移植替代物。
