胫骨骨折不愈合及畸形愈合的治疗现状及进展

王毅; 王建平; 李景峰; 柳峰

doi:10.3969/j.issn.2095-252X.2018.03.009

摘要：Objective Current literature suggested that supplemental bone grafting might be necessary in the setting of the atrophic nonunion. A number of surgical techniques had been described for the management of these injuries. However, optimal treatment was controversial, as discussed in the literature. This article highlights the current treatment options based on the existing literature and describes our preferred techniques. Methods We carried out a comprehensive review of PubMed and Medline databases using multiple keywords ( eg, "tibial fracture; tibial nonunion; tibial malunion; tibial defect; tibial nonunion treatment and expectation" ) to identify the relevant literature regarding this topic. Reference lists of relevant articles were reviewed. Results Locking compression plate ( LCP ) technique was useful for nearly all fracture types, especially in epiphyseal tibial fracture. Intramedullary nailing ( IMN ) was used for stable tibial shaft fractures. Supplemental bone grafting may be necessary in the setting of atrophic nonunion. Huntington's procedure held a unique place for the treatment of large gap nonunions of the tibia, especially in paediatric patients. Masquelet technique or free vascularized bone grafting ( FVFG ) were optional for the treatment of long tibial defects. Ilizarov method could be used in the treatment of all kinds of complicated tibial nonunion, also as a remedial measure after the failure in other ways. Platelet-rich plasma was a safe and effective treatment method for the nonunion. ESWT or LIPUS could be considered as a non-invasive treatment for the nonunion of fractures. Conclusions It is still a challenging problem for nonunion and malunion of the tibial. Reliable bone union and improved knee and ankle joint functions can be expected with thoughtful surgical planning, appropriate implant choice, and meticulous surgical technique.