Saka Gürsel, Sağlam Necdet, Kurtulmuş Tuhan, Avcı Cem Coşkun, Akpınar Fuat
Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
Department of Orthopedics and Traumatology, Abant İzzet Baysal University, Faculty of Medicine, Bolu, Turkey.
Acta Orthop Traumatol Turc. 2014;48(3):262-70. doi: 10.3944/AOTT.2014.3259.
The aim of this study was to evaluate the outcome of tricorticocancellous autologous bone grafting with intramedullary forearm nails in the treatment of radius or ulna aseptic nonunion.
The study included 8 patients (mean age: 39 years; range: 19 to 55 years) who underwent plate-screw osteosynthesis for the treatment of nonunion (6 ulna, 2 radius) following forearm fracture. In all cases, the length of the applied tricortical graft was below 3 cm. Patients were evaluated using the visual analog scale, Grace and Eversmann scale and DASH score. Wrist flexion and extension and postoperative hand and forearm grip strength were assessed.
Graft incorporation and union was completed at a mean of 22 (range: 18 to 28) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up ranged from 18 to 52 months. Radiographic union was achieved in all patients. Mean visual analog scale pain score was 1 (range: 0 to 3). Grace and Eversmann ratings were excellent in 5 and good in 3 patients. Mean DASH score was 10.7 (range: 1.7 to 21.7) points.
Intramedullary nailing and tricorticocancellous iliac bone block grafting appears to be a technically easy and reliable procedure that enables early postoperative rehabilitation in the treatment of nonunion of the forearm.
本研究旨在评估采用带锁髓内钉结合三皮质松质骨自体骨移植治疗桡骨或尺骨无菌性骨不连的疗效。
本研究纳入8例患者（平均年龄39岁；范围19至55岁），这些患者因前臂骨折后骨不连（6例尺骨，2例桡骨）接受钢板螺钉内固定治疗。所有病例中，应用的三皮质骨移植长度均小于3 cm。采用视觉模拟评分法、Grace和Eversmann评分法以及DASH评分对患者进行评估。评估腕关节屈伸活动度以及术后手部和前臂握力。
移植骨融合和骨愈合平均在22周（范围18至28周）完成。无患者发生骨不连、深部感染或桡尺骨融合。随访时间为18至52个月。所有患者均实现影像学骨愈合。视觉模拟评分法的平均疼痛评分为1分（范围0至3分）。Grace和Eversmann评级中，5例为优，3例为良。DASH评分平均为10.7分（范围1.7至21.7分）。
髓内钉固定联合三皮质松质骨髂骨块移植似乎是一种技术上简单且可靠的方法，可使前臂骨不连患者术后早期进行康复治疗。
