双钢板联合自体骨移植治疗无菌性肱骨干骨折不愈合  

Double plate combined with autogenous bone graft for the treatment of aseptic humeral diaphyseal nonunion

作　　者：刘彬彬 徐飞 刘阳 黄创 曾云浩 罗政强 Liu Binbin;Xu Fei;Liu Yang;Huang Chuang;Zeng Yunhao;Luo Zhengqiang(Department of Orthopedics,Tongji Hospital of Tongji Medical College,Huazhong University of Science&Technology,Wuhan Hubei,430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,湖北武汉430030

出　　处：《生物骨科材料与临床研究》2023年第1期67-70,75,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：湖北省基金面上项目(2021CFB350)。

摘　　要：目的 探讨双钢板联合自体骨移植治疗肱骨干无菌性骨折不愈合的疗效。方法 回顾性分析2017年4月至2021年6月期间于华中科技大学同济医学院附属同济医院行双钢板内固定联合自体骨移植治疗的10例肱骨干骨折不愈合病例。其中,男7例,女3例;年龄20~68岁,平均年龄45.1岁。初次内固定方式:7例3.5 mm LCP,2例3.5 mm双钢板,1例髓内钉。其中4例初次手术的内固定失效;骨折不愈合分型:有活性骨折不愈合4例,无活性骨折不愈合6例。二次术后行X线或CT检查评估骨折愈合情况。主要观察指标为术前、术后3个月和末次随访时间的MEPI肘关节和Constant-Murley评分。结果 平均随访时间为14个月(10~24个月)。所有骨折不愈合均愈合,平均愈合时间4.7个月(3.5~7个月),未出现并发症。术后3个月时MEPI评分(82.50±10.61)分,Constant-Murley评分(79.60±6.11)分;末次随访,MEPI评分(88.50±5.30)分,Constant-Murley评分(86.90±4.12)分,较术前明显改善。结论 双钢板内固定联合自体骨移植治疗肱骨干骨折不愈合疗效满意。使用双钢板可以提高固定的稳定性,有利于早期功能锻炼,促进骨折愈合。Objective To investigate the efficacy of double plate combined with autogenous bone graft in the treatment of aseptic nonunion of the humeral shaft. Methods From April 2017 to June 2021, 10 cases of humeral diaphyseal nonunion treated with double plate internal fixation combined with autogenous bone graft in Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology were retrospectively analyzed. There were 7 males and 3 females,aged from 20-68 years, with an average age of 45.1 years. Initial internal fixation included 3.5 mm LCP in 7 cases, 3.5 mm double plate in 2 cases, and intramedullary nail in 1 case. Four cases had internal fixation failure. Weber and Cech nonunion classification: 4 cases were capable of biological reaction and 6 cases were inactive nonunion. Fracture healing was evaluated by X-ray or CT. The main outcome measures were the Mayo Elbow Performance Index and the ConstantMurley score before the operation, 3 months after operation, and at the last follow-up. Results The mean follow-up time was 14 months(range, 10-24 months). All patients healed in an average of 4.7 months without complications. Three months after the operation, the MEPI score was 82.50±10.61, and the Constant-Murley score was 79.60±6.11. At the last follow-up, the MEPI score was 88.50±5.30, and the Constant-Murley score was 86.90±4.12, which were significantly improved compared with preoperative scores. Conclusion Satisfactory results of double plates internal fixation combined with autogenous bone grafting in the treatment of nonunion of the humeral shaft. Double plates fixation can improve the stability of fixation, facilitate early functional exercise and promote fracture healing.

关 键 词：双钢板 肱骨干 内固定 骨折不愈合 

分 类 号：R683.42[医药卫生—骨科学]