通道成骨技术治疗锁骨萎缩性骨不连的初步疗效观察  

Channel bone grafting in treatment of postoperative atrophic nonunion of clavicular fracture

作　　者：张聪明[1] 李忠[1] 王谦[1] 马腾[1] 薛汉中[1] 孙亮[1] 刘路 许毅博 张诚诚 张堃[1] 王德智 段宁[1] Zhang Congming;Li Zhong;Wang Qian;Ma Teng;Xue Hanzhong;Sun Liang;Liu Lu;Xu Yibo;Zhang Chengcheng;Zhang Kun;Wang Dezhi;Duan Ning(Department of Orthopaedics and Traumatology,Xi'an Hong-Hui Hospital,Xi'an Jiaotong University College of Medicine,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科医院下肢病区,西安710054

出　　处：《中华创伤骨科杂志》2022年第2期107-113,共7页Chinese Journal of Orthopaedic Trauma

基　　金：陕西省科技计划项目(2019SF-049)。

摘　　要：目的探讨通道成骨技术即保留骨不连断端硬化骨质联合有限接触动力加压锁定钢板(LC-DCP)治疗锁骨中段骨折术后骨不连的临床疗效。方法回顾性分析2015年6月至2019年12月期间西安交通大学附属红会医院创伤骨科收治且完整随访的41例锁骨中段骨折内固定术后萎缩性骨不连患者资料。男23例,女18例;平均年龄为47.6岁(28~63岁);左侧25例,右侧16例。患者骨不连手术与骨折初次手术的时间间隔平均为18.5个月(9~40个月);入院前有1次手术36例,2次手术5例。术中测量骨不连缺损长度,骨不连均采用建立植骨通道,取髂骨植骨联合锁骨上方LC-DCP内固定。术后12个月采用上肢功能障碍评分(DASH)评估患侧功能。结果41例患者术后获平均13.6个月(12~15个月)随访。25例患者骨缺损长度≤2.0 cm,16例患者骨缺损长度>2.0 cm。所有患者骨不连均获愈合,愈合时间平均为14周(12~16周)。1例患者术后出现供区持续疼痛,1例患者出现右下肢深静脉血栓形成。术后12个月DASH评分平均为14.7分。结论通道成骨技术保留了萎缩性骨不连断端的硬化骨,减少了髂骨的取骨量,治疗锁骨萎缩性骨不连可取得较好的疗效。Objective To evaluate the clinic efficacy of channel bone grafting[preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate(LC-DCP)]in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology,Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019.They were 23 males and 18 females,with a mean age of 47.6 years(from 28 to 63 years).The left side was affected in 25 cases and the right side in 16 cases.The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months(from 9 to 40 months).Thirty-six cases had undergone one operation and 5 cases 2 operations before admission.The length of bone defect was measured during operation.All nonunions were treated with construction of a graft channel,iliac bone graft and LC-DCP internal fixation above the clavicle.The upper limb function of the affected side was evaluated by the Disabilities of Arm,Shoulder and Hand(DASH)12 months after operation.Results The 41 patients were followed up for an average of 13.6 months(from 12 to 15 months).A bone defect≤2.0 cm was found in 25 cases and that>2.0 cm in 16 ones.Nonunion healed in all patients after an average time of 14 weeks(from 12 to 16 weeks).One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb.The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture,because it preserves the sclerotic bone at the broken nonunion ends,reduces the amount of iliac bone graft and leads to fine clinic efficacy.

关 键 词：锁骨 骨移植 骨折 不愈合 通道技术 萎缩性骨不连 

分 类 号：R687.3[医药卫生—骨科学]