髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连  

Humeral diaphyseal nonunions treated by interlocking or expandable intramedullary nailing plus lilac bone grafting

作　　者：范存义[1] 蔡培华[1] 阮洪江[1] 孙鲁源[1] 姜佩珠[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2011年第3期247-250,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连的疗效。方法1999年6月至2008年5月共收治27例肱骨干骨不连患者，男14例，女13例；年龄24—65岁．平均35．5岁；左侧11例，右侧16例；骨不连部位：中上段6例，中段16例，中下段5例。骨不连类型：肥大型22例，萎缩型5例。所有患者均有1～4次手术史，平均2．3次。16例采用肱骨交锁髓内钉固定，其中1例闭合穿髓内钉，5例采用更换原髓内钉后外加钢缆张力带固定；11例采用肱骨膨胀髓内钉。除1例闭合复位固定的患者外，其余26例患者均行自体髂骨植骨。结果26例患者术后获1年3个月至8年6个月（平均4年2个月）随访，骨不连均获骨性愈合，愈合时间为4～8个月（平均5．4个月）。肩关节功能按Neer评分标准评定：优12例，良8例，可6例，优良率为76．9％。肘关节功能按Mayo评分标准评定：优23例，良3例，优良率为100％。1例桡神经损伤患者术后6个月恢复伸腕、伸拇及伸指功能。结论肱骨髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连具有骨愈合率高、对肩肘关节影响小等优点。Objective To discuss the efficacy of interlocking or expandable intramedullary nailing plus lilac bone grafting h,r treatment of humeral diaphyseal nonunion. Methods From June 1999 to May 2008, 27 eases of humeral diaphyseal nonunion, 14 males and 13 females, were treated in our deparhuent. The nonunions occurred at the upper-middle humerus in 6 cases, at the middle humerus in 16 cases and at the middle-h,wer homerus in 5 eases. The patients had previously undergone operations for I to 4 times （average, 2.3 times） . Interlocking nailing was applied in 16 eases （including one ease of close nailing and 5 cases of cable tension band osteosynthesis after replacement of tire original nailing）; expandable nailing was applied in 11 cases. Autologous lilac bone grafting was perfunned in 26 eases except the one case of close nailing. Results Twenty-six eases were followed up for an average of 4 years and 2 months. Bony healing was obtained in 5.4 mouths ou average. By Neer scoring, the shouhter functions were evaluated as excellent in 12, good in 8 and fair in 6 eases, with a good to exeellent rate of 76. 9%. By Mayo clinic perforumnce scoring, the elbow fimetiuns were excellent in 23 and good in 3 cases, with a good to excellent rate of 100%. One case of radial nerve palsy recovered 6 months after operation. Conclusion Interlocking or expandable intramedullary nailing plus iliae bone grafting is an effective method to treat nonunion of humeral diaphysis.

关 键 词：肱骨骨折 骨折 不愈合 骨钉 骨折固定术 内 

分 类 号：R686[医药卫生—骨科学]