| Objective:To investigate the causes and clinical treatment for different types of nonunion of tibial shaft fracture nonunionMethod: The clinic data of 45 cases from April 2010-January 2015 were analyzed retrospectively(30 males and 15 females,aged 17-75 years,mean 45.7 years old,the upper 1/3 section 11 cases,the middle 1/3 segment 11 cases,the distal 1/3 segment23 cases.Injury factors: traffic accident in 30 cases,falls in 2 cases,heavy injured in 2cases,11 cases happen after other accident.27 cases are open fractures,according to Gustilo-Anderson typing: 7 cases are type I,12 cases are type Ⅱ,8 cases are typeⅢ;18 cases are closed fracture,which according to the AO classification: 42-A type 5cases,42-B 6 cases,42-C 7 cases.17 cases of smoking and 28 nonsmoking,3 cases had high blood sugar before surgery,the rest are normal),These patients were divided into three groups,atrophic nonunion group of 16 patients,hypertrophic nonunion group of 14 patients and infected nonunion group of 15 cases.All of atrophic nonunion use bone grafts,seven cases replace locking compression plate,three cases replace reamed intramedullary nail,4 cases retain the original fixtures,only simple plant bone,2 cases take external fixation;14 patients with hypertrophic nonunion,7 were replaced with compression plate fixation,7 cases replace intramedullary nailing,8 cases bone graft,6 cases without bone graft;15 patients with infected nonunion are using external fixation.All of the infection nonunion are not bone graft.Observation and statistical indicators including three groups of nonunion bone healing time,lower limb function score reference John-Wruh efficacy evaluation criteria,six months after callus growth.In this study,statistics data using SPSS17.0 statistical software analysis,each group of data using a group rank test was used for comparison,P <0.05 difference was statistically significant.Result:nonunion common causes include: systemic factors,blood supply,fixation instability,poor contact and infection.The group of 45 patients were followed up for diagnosis of nonunion time 5-36 months,an average of 16.2 months,Use X-ray after the intervention and the first month after treatment and then every 1-3 months review of X-ray to bone healing,the damage of internal fixation was not found,all nonunion reached bone union,which atrophic nonunion: healing time 6.0 ± 1.2 months;callus growth rates 3.6 ± 0.6;lower limb function score 90.3 ± 4.4,hypertrophic nonunion:healing time 5.7 ± 1.0 months;callus score 3.8 ± 0.4;lower limb function score 92.7 ±2.6,infected nonunion: healing time 10.4 ± 1.8 months;callus growth rates lower limb function score 2.0 ± 0.6 81.3 ± 8.8,compared to infected nonunion hypertrophy nonunion and atrophy nonunion,the infected nonunion have a long healing time,and lower level function.Conclusion:1.The reason this group of patients nonunion were: hypertrophic nonunion mainly choose internal fixation is not stable enough,atrophic nonunion mainly due to poor local blood supply,infected nonunion occurred is the cause of more severe trauma and iatrogenic factors is the main reason,;2.If only keep stability,all the hypertrophic nonunion can achieve bone healing no matter which ways to choose;atrophic nonunion should be avoid damage to the local blood supply,bone graft should be used in all atrophic nonunion cases,infected nonunion are taking external fixator,the infection should not use bone graft before the infect is control;3.Comparative Efficacy: hypertrophic nonunion have best effect,atrophic nonunion Secondly,infected nonunion is the worst. |
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