锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连  

Locking compression plates and autologous bone graft for the humeral shaft nonunion after surgical failure

作　　者：王军强[1] 赵春鹏[1] 龚晓峰[1] 张健[1] 李宁[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2012年第2期127-131,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连的手术技巧与临床疗效. 方法 回顾性分析2006年3月至2008年6月收治且获得随访的26例肱骨干骨折术后骨不连患者资料,男19例,女7例；平均年龄为46 7岁（19 ～63岁）.骨不连类型：肥大型17例,萎缩型7例,假关节型2例.患者本次手术与上次手术的时间间隔平均为9.3个月（9.1～9.6个月）.22例内固定治疗的患者行原内固定物取出、切开复位、自体髂骨植骨锁定加压接骨板内固定术,4例带外固定支架患者先去除外固定支架,行石膏固定1个月后再行切开复位、自体髂骨植骨锁定加压接骨板内固定术.术后肩关节及肘关节功能评估分别采用Constant肩关节评分和Mayo肘关节评分.结果 26例患者术后获平均25.6个月（25～33个月）随访.25例患者术后骨折获愈合,平均愈合时间为5 2个月（4 ～9个月）；1例因术后伤口感染致骨折不愈合,经抗感染治疗5个月后骨折获愈合.2例发生桡神经不全损伤.Constant肩关节评分平均为（79.1±0.1）分,Mayo肘关节评分平均为（85 7±0 8）分.结论 锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连的关键是尽量彻底清理骨折断端、加压、充分有效的自体髂骨植骨.该方法可以极大地提高骨折愈合率,减少并发症的发生,且能获得较好的肩、肘功能.Objective To evaluate the efficacy of secondary revision with locking compression plates （LCP） and autologous bone graft for nonunion of humeral shaft fracture after surgical failure. Methods Included in this study were 26 patients with nonunion of humeral shaft fracture after various surgical treatments who had received secondary revision with LCP and autologous iliac graft in our department between March 2006 and June 2008 and had been fully followed.They were 19 men and 7 women,with an average age of 46.7 years （range,19 to 63 years）.There were 17 cases of hypertrophic nonunion,7 cases of atrophic nonunion and 2 cases of pseudarthrosis.The mean interval between the primary operative treatment and the secondary revision was 9.3 months （from 9.1 to 9.6 months）. All nonunions were managed with removal of previous implants,open reduction and internal fixation with LCP,supplemented by cancellous bone graft.Functional recovery was evaluated by Mayo Elbow Performance Index and the modified scale of Constant and Murley. Results The average follow-up was 25.6 months （range,25 to 33 months）.The secondary revision led to postoperative bone union in 25 patients after a mean time of 5.2 months （range,4 to 9 months）.Only one patient suffered nonunion caused by wound infection before he eventually obtained bone union after anti-infective therapy for 5 months.Temporary palsy of the radial ncrve occurred in 2 cases.The mean functional scores for the shoulder （Constant） and the elbow （Mayo） were 79.1 ±0.1 and 85.7 ±0.8,respectively.Conclusions In revision of the nonunion of humeral shaft fracture after surgical failure,LCP and autologous bone graft can greatly increase the rate of union and reduce complications to ensure good functional recovery of the upper extremity.We believe the key to the procedure lies in complete resection of the nonunion ends and fibrous tissue,cortex-to-cortex apposition with stalwart compression across the entire site and wide use of autologous bone.

关 键 词：肱骨骨折 骨折 不愈合 骨折固定术 内 骨板 

分 类 号：R687.3[医药卫生—骨科学]