摘要目的：探讨外固定架辅助髓内钉技术对大段骨缺损致骨不连患者临床疗效及预后的影响。方法选择2007年4月至2012年10月平煤神马医疗集团总医院收治的胫骨大段骨缺损致骨不连患者94例，分为研究组52例和对照组42例。研究组患者予以外固定架辅助交锁髓内钉手术方案，对照组患者予以改良植骨手术方案。随访12～24个月，比对两组患者治疗前后Paley评分、美国膝关节协会（AKSS）评分及Baird-Jackson踝关节评分等指标差异，记录其术后骨折愈合时间、膝关节活动度范围、机械轴向偏向及患肢较健侧长度缩短值等治疗指标变化情况，分析并发症发生率、疼痛评分、睡眠质量评分等预后指标差异。结果（1）治疗后，两组患者Paley评分、AKSS评分及Baird-Jackson评分等均较治疗前显著提高（P<0.05），其中研究组增幅大于对照组（P<0.05）。（2）研究组患者术后骨折愈合时间、机械轴向偏向及患肢较健侧长度缩短值等均显著低于对照组患者，膝关节活动度范围则明显高于对照组患者（P<0.05）。（3）研究组患者术后骨折愈合率为100.0%，显著高于对照组的76.2%（P<0.05）；对照组患者术后并发症发生率为38.1%，显著高于研究组的3.8%（P<0.05）；术后研究组NRS评分及PSQI评分均显著低于对照组患者。结论对胫骨大段骨缺损致骨不连患者予以外固定架辅助髓内钉技术治疗，疗效确切，可有效提高其膝关节及踝关节功能，对促进骨折愈合、改善患者预后具有积极影响，值得临床推广。

abstractsObjective To explore the effect of external fixator assisted intramedullary nail on the clinical outcome and prognosis of patients with nonunion caused by segmental bone defect. Methods 94 cases of patients with nonunion caused by tibial segmental bone defect were retrospectively divided into two groups:observation group and control group . observation grou were treated with external fixator combined with interlocking intramedullary nail while control group with improved bone grafting operation scheme. With 12 to 24 months of follow-up in the period of behavior,Paley score, the American Knee Society Score (AKSS) and Baird-Jackson ankle joint score before and after the treatment were compared between the two groups. The changes of time for fracture healing after operation, the range of knee joint activity, mechanical axial deviation, the value of contraction in length of the healthy side in limb and other treatment indexes were recorded. And differences in the occurrence rates of complications, pain score, score of sleep quality and other prognostic indicators were analyzed. Results ①After the treatment, AKSS and Baird-Jackson ankle joint score in the two groups were significantly improved, compared with those before the treatment (P<0.05) and the amplification of observation group was greater than that of control group(P<0.05); ②The time of fracture healing after operation, mechanical axial deviation, the value of contraction in length of the healthy side in limb and other treatment indexes in observation group were lower than those in control group while the range of knee joint activity was significantly higher than that of control group(P<0.05);③The rate of fracture healing in observation group was 100%which was significantly higher than 76.2%in control group(P<0.05);the rate of complication in control group was 38.1%which was significantly higher than 3.8%in observation group (P<0.05). Conclusion The treatment of bone defects caused by large bone defect of tibia with external fixation is an effective treatment for the patients with bone nonunion. It has a positive effect on improving the prognosis of patients. It is worthy of clinical promotion.