Gupta Dinesh K, Kumar Gaurav
Department of Orthopaedics, MLB Medical College, Jhansi, Uttar Pradesh, India.
Indian J Orthop. 2010 Jan;44(1):84-8. doi: 10.4103/0019-5413.58611.
The management of an atrophic nonunion with a gap following a fracture of the radius and/or ulna is a challenging problem. Various methods of treatment available in the literature are cortical tibial graft (Boyd), ulnar segment graft (Miller and Phalen), iliac crest graft (Spira), cancellous insert graft (Nicoll), vascularized fibular graft (Jupiter), and bone transport by ring fixator (Tesworth). The present study reports the results of tricorticocancellous bone block grafts using modified Nicoll's technique, in diaphyseal defects of forearm bones.
A total of 38 forearm bones (either radius or ulna or both) in 23 patients with a gap of 1.5-7.5 cm were treated by debridement and tricorticocancellous bone block graft under compression with intramedullary nail fixation between June 1985 and June 2005. There were 15 male and 8 female patients. Sixteen patients had open and seven patients had closed fractures initially. Time of presentation since the original injury varied from 9 months to 84 months. Eighteen patients had already undergone one to three operations.
Thirty-six bones showed union at both host graft junctions. The mean duration of union was 17.5 weeks (range, 14-60 weeks). Two bones had union only at one host graft junction and did not show any evidence of callus formation up to 9 months on the other end, hence requiring subsequent procedure in the form of phemister bone grafting. Patients were followed for a minimum period of 2 years (range, 2-7 years). Results were based on the status of union and range of motion (ROM) for elbow/wrist and grip strength at the final follow-up. Complications observed were the reactivation of infection (n = 1) and herniation of the muscles at the donor site (n = 1).
The tricorticocancellous strut bone grafting under optimal compression, augmented with intramedullary fixation, provides a promising solution to difficult problem of an atrophic nonunion of forearms bones with gap.
桡骨和/或尺骨骨折后伴有骨缺损的萎缩性骨不连的处理是一个具有挑战性的问题。文献中可用的各种治疗方法有皮质胫骨移植（博伊德法）、尺骨段移植（米勒和法伦法）、髂嵴移植（斯皮拉法）、松质骨植入移植（尼科尔法）、带血管腓骨移植（朱庇特法）以及环形固定器骨搬运（特斯沃思法）。本研究报告了采用改良尼科尔技术进行三皮质松质骨块移植治疗前臂骨干缺损的结果。
1985年6月至2005年6月期间，对23例患者共38块前臂骨（桡骨、尺骨或两者皆有）进行了清创和三皮质松质骨块移植，并在加压下采用髓内钉固定，骨缺损间隙为1.5 - 7.5厘米。其中男性15例，女性8例。16例患者最初为开放性骨折，7例为闭合性骨折。自原始损伤至就诊时间从9个月至84个月不等。18例患者已经接受过一至三次手术。
36块骨在宿主与移植骨连接处均实现了骨愈合。平均愈合时间为17.5周（范围为14 - 60周）。两块骨仅在一端的宿主与移植骨连接处实现了骨愈合，另一端在9个月时未显示任何骨痂形成迹象，因此需要后续进行菲米斯特植骨术。对患者进行了至少2年（范围为2 - 7年）的随访。结果基于最终随访时的骨愈合状态、肘/腕关节活动范围（ROM）以及握力。观察到的并发症有感染复发（1例）和供区肌肉疝出（1例）。
在最佳加压条件下进行三皮质松质支柱骨移植，并辅以髓内固定，为前臂骨伴有骨缺损的萎缩性骨不连这一难题提供了一个有前景的解决方案。
