Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2011 Mar 2;93(5):485-92. doi: 10.2106/JBJS.J.00342.
Information regarding the long-term outcomes of the treatment of lower-extremity fracture malunion and nonunion is lacking.
Twenty-nine secondarily referred patients with complex malunion or nonunion of the tibia or femur, treated by a single surgeon, were followed for a median of twenty years (range, twelve to thirty-five years) after injury. The patients were referred at a median of twenty months (range, 1.5 to 360 months) postinjury and had undergone a median of three prior surgical procedures (range, zero to twenty-eight). At the time of final follow-up, patient-based outcomes, patient satisfaction, and pain were evaluated.
All twenty-nine patients had healing following treatment of the complex malunion or nonunion of the tibia or femur and were able to bear full weight and walk one block or more. The Lower Extremity Functional Scale (LEFS) outcome tool revealed that twenty patients (69%) experienced moderate-to-severe difficulties in carrying out activities because of their lower-limb disability. The median Short Form-36 (SF-36) score was 67, with a median physical component score of 61 and a median mental component score of 71, indicating substantial impact on physical health status when compared with the norm.
Reconstruction can be a worthwhile endeavor and should be considered for all patients with complex malunion or nonunion of the tibia or femur.
关于下肢骨折畸形愈合和不愈合治疗的长期结果的信息尚缺乏。
由一位外科医生治疗的 29 例复杂胫骨或股骨畸形愈合或不愈合的再次转诊患者，在受伤后平均随访 20 年（范围为 12 至 35 年）。患者在受伤后平均 20 个月（范围为 1.5 至 360 个月）转诊，平均接受过 3 次先前的手术（范围为 0 至 28 次）。在最终随访时，评估了患者为基础的结果、患者满意度和疼痛。
所有 29 例患者的复杂胫骨或股骨畸形愈合或不愈合均愈合，能够完全负重并行走一个街区或更多。下肢功能量表（LEFS）结果工具显示，20 例（69%）患者因下肢残疾而在进行活动时存在中度至重度困难。SF-36 简表的中位数为 67，其中身体成分得分为 61，心理成分得分为 71，与常模相比，对身体健康状况有很大影响。
对于所有胫骨或股骨复杂畸形愈合或不愈合的患者，重建都是一项有价值的努力，应予以考虑。
