Tang Yanfeng, Yang Yuxia, Li Hongjun, Xi Jianing, Ye Ye, Yue Chen, Liu Youwen
Hip Injury Center, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Aug 15;34(8):1012-1017. doi: 10.7507/1002-1892.201912028.
To investigate the effectiveness of the treatment under the guidance of "diamond concept" for femoral shaft fractures nonunion after intramedullary fixation.
Between January 2014 and December 2016, 21 cases of femoral shaft fractures nonunion after intramedullary fixation were treated with auxiliary plate fixation combined with autogenous iliac graft, and autologous bone marrow concentrate and platelet-rich plasma (PRP) gel under the guidance of the "diamond concept". There were 13 males and 8 females, with an average age of 32.5 years (range, 17-48 years). All fractures were closed femoral shaft fractures. Four patients underwent internal fixation with plate and resulted in nonunion, then they were fixed with intramedullary nails, but did not heal either. The rest 17 patients were fixed with intramedullary nailing. Fracture nonunion classification: 4 cases of hypertrophic nonunion, 17 cases of atrophic nonunion; the length of bone defect was 1-3 mm; the duration from the last treatment to the current treatment was 10-23 months (mean, 14.3 months). The operation time, intraoperative blood loss, the time between operation and full loading, fracture healing time, and complications were recorded. The visual analogue scale (VAS) score and the imaging system of fracture healing of the extremities (RUST) of patients before operation and at last follow-up were recorded to evaluate the fracture healing; the function of the affected limb was evaluated according to the Schatzker-Lambert efficacy score standard at last follow-up.
The operation time was 105-160 minutes, with an average of 125.6 minutes; the intraoperative blood loss was 160-580 mL, with an average of 370.5 mL. All incisions healed by first intention, without vascular or nerve injury. All patients were followed up 22-46 months (mean, 26.5 months). All the fractures healed, with a fracture healing time of 3-7 months (mean, 4.8 months). During the follow-up, there was no infection, loosening, implant breakage, re-fracture, and other complications. The VAS score at last follow-up was 0.8±0.3, showing significant difference ( =7.235, =0.000) when compared with preoperative score (5.2±3.7); the RUST score was 3.4±0.3, which was significantly higher than the preoperative score (1.5±0.7) ( =8.336, =0.000). According to the Schatzker-Lambert effectiveness evaluation standard, the limb function was excellent in 16 cases, good in 4 cases, fair in 1 case, and the excellent and good rate was 95.42%.
Nonunion after intramedullary fixation of femoral fracture treated with auxiliary plate combined with autogenous iliac graft, autogenous bone marrow concentration and PRP gel in accordance with the "diamond concept" can not only restore the stability of the fracture ends, but also improves the biological environment of the fracture site, and can improve the rate of fracture healing.
探讨“钻石概念”指导下治疗股骨干骨折髓内固定术后骨不连的疗效。
2014年1月至2016年12月，对21例股骨干骨折髓内固定术后骨不连患者采用辅助钢板固定联合自体髂骨移植，并在“钻石概念”指导下应用自体骨髓浓缩物和富血小板血浆（PRP）凝胶治疗。男13例，女8例，平均年龄32.5岁（17 - 48岁）。所有骨折均为闭合性股骨干骨折。4例患者曾行钢板内固定导致骨不连，后行髓内钉固定，仍未愈合。其余17例患者行髓内钉固定。骨折不连分类：肥大性骨不连4例，萎缩性骨不连17例；骨缺损长度为1 - 3mm；上次治疗至本次治疗时间为10 - 23个月（平均14.3个月）。记录手术时间、术中出血量、手术至完全负重时间、骨折愈合时间及并发症。记录患者术前及末次随访时的视觉模拟评分（VAS）及肢体骨折愈合影像系统（RUST）评分以评估骨折愈合情况；末次随访时根据Schatzker - Lambert疗效评分标准评估患肢功能。
手术时间为105 - 160分钟，平均125.6分钟；术中出血量为160 - 580mL，平均370.5mL。所有切口均一期愈合，无血管或神经损伤。所有患者随访22 - 46个月（平均26.5个月）。所有骨折均愈合，骨折愈合时间为3 - 7个月（平均4.8个月）。随访期间无感染、内固定松动、植入物断裂、再骨折等并发症。末次随访时VAS评分为0.8±0.3，与术前评分（5.2±3.7）比较差异有统计学意义（ =7.235， =0.000）；RUST评分为3.4±0.3，显著高于术前评分（1.5±0.7）（ =8.336， =0.000）。根据Schatzker - Lambert疗效评价标准，肢体功能优16例，良4例，可1例，优良率为95.42%。
按照“钻石概念”采用辅助钢板联合自体髂骨移植、自体骨髓浓缩物及PRP凝胶治疗股骨干骨折髓内固定术后骨不连，不仅能恢复骨折端稳定性，还能改善骨折部位生物环境，并可提高骨折愈合率。
