Department of Orthopaedics, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, People's Republic of China.
Arch Orthop Trauma Surg. 2011 Jul;131(7):885-91. doi: 10.1007/s00402-010-1226-9. Epub 2010 Dec 17.
Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects.
Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted.
The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain.
The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.
下肢长骨骨不连是骨科创伤的常见并发症，可能会导致严重的身体残疾。本回顾性研究描述了我们使用可膨胀髓内钉和自体骨移植治疗下肢长骨骨不连伴骨缺损的经验。
19 例下肢长骨骨不连伴股骨干或胫骨干骨折类型所致骨缺损患者（平均年龄 38.9 岁，范围 18-61 岁），其中 A2 型（3 例股骨，1 例胫骨）、A3 型（1 例股骨，2 例胫骨）、B2 型（3 例股骨，4 例胫骨）和 B3 型（1 例股骨，4 例胫骨）。采用可膨胀髓内钉和自体骨（髂骨和/或腓骨）移植治疗。术后每 4 周通过标准前后位和侧位 X 线片分析判断骨愈合情况。记录并发症。
患者平均既往手术次数为 1.9 次（范围 1-4 次）。从原始损伤到治疗的平均时间为 17.6 个月（范围 9-40 个月）。股骨干骨不连术后平均 26.5 周（范围 16-60 周）愈合，胫骨干骨不连术后平均 23.6 周（范围 12-40 周）愈合。除 2 例分别发生慢性术后骨髓炎和延迟愈合的患者外，其余患者均获得 I 型愈合。2 例患者术后诉供区疼痛。
使用可膨胀髓内钉和自体骨移植是治疗下肢骨折合并骨缺损骨不连的有效方法，并发症少。
