关键词: 股骨远端骨折, 　内固定, 　骨不连, 　附加钢板技术

Abstract:

Objective　To summarize the indications, mechanism and efficacy of augmentation plating technique in the treatment of nonunion of distal femoral fractures after lateral plating.　Methods　30 cases of non-infective nonunion of distal femoral fractures after lateral plating were treated with augmentation plating technique. All were atrophic nonunion. A reconstruction plate was used by a small medial incision and iliac autogenous bone graft was performed. Early rehabilitation was taken postoperatively. The healing time and complications were recorded; comparison of the range of movement of knee between pre-op and post-op at follow-up was made, and the functional recovery of the affected limb by Schatzker-Lambert score system was evaluated.　Results　All incisions healed by first intention. All patients were followed up for 32 to 12 months with an average of 16.3 months. All fractures healed within 3 to 6 months, with an average of 4.6 months. No infection and injury of nerve and vessel, no loosening or breaking of plate and screw were noted. At the last follow-up, the range of movement of knee (100.10±23.31)°  was significantly improved compared to that of the preoperative（55.29±23.01)°（t=-4.911，P=0.000）; the functional recovery of the affected limb was excellent in 9 cases, good in 16 cases, fair in 3 cases and poor in 2 cases (the excellent and good rate was 83.33%).　Conclusion　 Augmentation plating technique is indicated for aseptic nonunion of distal femoral comminuted fractures after lateral plating without loosening or breaking of internal fixation, which has characteristics of less trauma, early rehabilitation, high rates of healing and satisfactory of functional recovery as long as performed according to its principles.

Key words: Distal femoral fracture, 　Internal fixation, 　Nonunion, 　Augmentation plating technique