The Clinical Research Of The Treatment Of Nonunion With Sliding Bone Graft And Locking Compression Plate

Objective:With the accelerating development of modernization process, the high-energy and complicated injuries of long bone fractures that caused by traffic accidents and industrial damages are increasing. The majority of clinicians generally accept the internal fixation surgery as a routine treatment. With the increase in the number of patients who accept the internal fixation surgery, the incidence of nonunion of fracture is usually high, which is even up to 5% to 10% after the internal fixation. Nonunion of fracture usually happen in the limbs after long bone fracture. The etiopathogenisis is very complex, often caused by a number of factors, such as poor blood supply of the fractured location, fractured reposition is not satisfied, the paratope of broken ends of fractured bone is not ideal, the bone defect of the fractured location, the soft tissue insert in broken ends of fractured bone, the choice of internal fixity is not appropriate, the fixity is not enough firmly, the infection and many other factors. According to the current point of view, whether foreign or local scholars believe that nonunion is the termination of the normal fractured healing process, and the extending treatment time if without the intervention of clinical treatment is still ineffective. The treatment of nonunion of fracture is more difficult than fresh fracture, and the prognosis is even worse. It often demands multiple surgeries, as the thorny problems recognized by the clinicians. It brings pain, limb dysfunction, large of the economic cost and other various adverse outcomes, extends the patient's sick time and also causes damage to patients with mental, physical and economic aspects. For the treatment of nonunion, the clinical surgical treatment is the main management,a variety of other treatments such as: extracorporeal shock wave therapy, autologous bone marrow transplantation, electrical and electromagnetic stimulation, ultrasound therapy, Chinese medicine, are supplemented. There is no uniform treatment and surgery method of nonunion now.But cleaning-up hardening tissue and fibrous scar tissue in the fractured location, eliminating the bone defect by bone graft,stripping periosteum less as possible, opening the medullary cavity, preserving and restoring the blood supply of bone fracture, providing strong and reliable fixation, is to become the generally accepted principles of the treatment of nonunion. Through observations of 20 cases of long bone nonunion since 2009, we investigate the superiority of the treatment of nonunion with sliding bone graft and locking compression plate, to increase the cure rate of nonunion and help the clinicians improve the surgical treatment of nonunion and elevate curative effect.Then we discuss other relevant issues of the treatment of nonunion either.Methods: Observation of 20 cases of nonunion since 2009 in The Third Hospital of He Bei Medical University, including 17 males and 3 females, aged 18 to 55 years, mean 36 years; fracture sites: 11 cases in the femur, 7 cases in tibia, 2 cases of humeral shaft; the time from the operation in local hospital to operation in our hospital, the minimum time 4.5 months, up to 30 months, an average of 14 months. The cases were followed up after surgery. We determine whether the fracture is clinical healing according to the clinical manifestations and X-ray of the patients. All the patients take X-ray check after operation. 3 months later, the patients can take gradual weight-bearing walking under the guidance of the doctor, then you can review an interval of 2-3 months until the fracture healed. We usually remove the internal fixation about 12-18 months after the operation according to the situation of fracture healing.Results: All patients were followed up for 16 to 24 months, an average of 20 months. 20 patients were all involved in fracture healing, the shortest healing time was 7 months and a maximum of 18 months, an average of 12 months, the fracture healing rate is100%.Conclusions: The treatment of nonunion with sliding bone graft and locking compression plate save bone mass, cause trauma tinily, clean-up ends in medullary cavity thoroughly, minimize the stripping of the periosteum to retain the the blood supply of the fractured location effectively. The sliding bone graft eliminates the fractured gap in the front side of the fractured location at least, and the fixed effect of LCP is stability. The operation is relatively simple, which is in favour of generalization in primary hospitals. The treatment can improve the cure rate of nonunion and the effect is exact, has certain superiority.