Therapeutic effect of double steel plate internal fixation combined with autogenous iliac bone grafting on aseptic nonunion after femoral shaft fracture / 国际外科学杂志

ABSTRACT

Objective:To investigate the effect of double steel plate internal fixation combined with autogenous iliac bone grafting on aseptic nonunion after femoral shaft fractures.Methods:Retrospective analysis of clinical data of 73 patients with aseptic nonunion after femoral shaft fracture treatment was performed in department of orthopedies, Honghui Hospital, Xi′an Jiaotong University from January 2017 to December 2018, there were 42 males and 31 females, aged 30 to 58 years, with an average age of 40.63 years. They were divided into control group ( n=33) and observation group ( n=40) according to different surgical methods, the control group was treated with intramedullary nail replacement, and the observation group was treated with double steel plate internal fixation combined with autogenous iliac bone grafting. The general indicators of perioperative period (intraoperative blood loss, duration of operation, postoperative drainage), bone nonunion healing, and surgical efficacy were compared between the two groups. The follow-up time in outpatient clinic was (15.24 ± 4.72) months, and the follow-up deadline was December 2019. At 6 months after surgery, joint function, joint mobility, visual analogue scale (VAS) and Oswestry disability index(ODI) were evaluated. Measurement data were expressed as mean ± standard deviation ( Mean ± SD), and comparison between groups was analyzed using independent sample t test. Count data were expressed as percentage (%), and comparison between groups was analyzed using χ2 test. Comparison of ordinal data was analyzed by Mann-whitney U non-parametric test. Results:The patients in both groups were followed up. The amount of intraoperative blood loss, duration of operation, and postoperative drainage [(201.6±38.4) mL, (138.7±22.7) min, (25.8±6.9) mL] in the observation group were significantly less than those in the control group [(278.5±40.6) mL, (171.4±20.1) min, (43.2±8.5) mL], the differences were statistically significant between the two groups ( P<0.05). Comparison of postoperative bone nonunion healing, the healing time of the observation group (5.15±0.42) months was significantly shorter than that of the control group (6.31±0.58) months, and the healing rate of the observation group (100%) was significantly higher than that of the control group (90.1%), the differences were statistically significant between the two groups ( P<0.05). After 6 months of follow-up, the excellent and good rate of joint function were compared between the two groups. The knee joint excellent and good rate (97.50%) and hip joint excellent and good rate (97.50%) in the observation group were significantly better than those of the control group (78.79%, 81.81%), the differences were statistically significant between the two groups ( P<0.05). Comparison of joint mobility between the two groups of patients, knee joint mobility [extension angle (0.64±0.14) °, flexion angle (138.72±6.37) °]and hip joint activity [adduction angle (35.13±9.44) °, the abduction angle (74.38±5.22) °] were significantly better than the knee joint mobility [extension angle (0.48±0.21) °, flexion angle (113.57±5.43) °] and hip joint motion [adduction angle (21.57±8.63) °, abduction angle (69.57±6.37) °], the differences were statistically significant between the two groups ( P<0.05). The VAS and ODI efficacy scores [(3.24±0.43), (23.45±4.77) scores]in the observation group were significantly better than those of the control group [(4.64±0.71), (27.25±4.38) scores] at 2 and 4 weeks after operation, the differences were statistically significant between the two groups ( P<0.05). Conclusions:The double steel plate internal fixation combined with autologous iliac bone grafting is ideal and significant in the treatment of aseptic nonunion after femoral shaft fracture. Meanwhile, it has the advantages of less trauma throughout the operation, quicker postoperative recovery, and significantly improved joint function. It is worthy of clinical application.