“通道成骨”技术治疗无菌性肱骨干骨不连的疗效分析  

Bone-forming channel technique in the treatment of aseptic humeral shaft nonunion

作　　者：程刚[1] 季建华 郭丰勇 文虹杰 陈仲 Cheng Gang;Ji Jianhua;Guo Fengyong;Wen Hongjie;Chen Zhong(Department of Orthopaedic and Traumatologic Surgery,The Hospital Affiliated to Yunnan University,Kunming 650021,China)

机构地区：[1]云南大学附属医院骨与创伤外科,云南省第二人民医院骨与创伤外科,昆明650021

出　　处：《中华创伤骨科杂志》2024年第8期679-684,共6页Chinese Journal of Orthopaedic Trauma

基　　金：云南省基础研究计划-昆医联合面上项目(202201AY070001-274);云南省基础研究计划(202401AT070455)。

摘　　要：目的探讨"通道成骨"技术结合双钢板治疗非感染性肱骨干骨折术后骨不连的疗效。方法回顾性分析自2018年3月至2022年12月以来采用"通道成骨"技术结合双钢板治疗的39例非感染性肱骨干骨折术后骨不连患者资料。男20例,女19例;年龄(46.5±1.6)岁;骨不连类型:萎缩型18例,肥大型21例。记录患者手术时间、术中出血量、骨折愈合时间及并发症,术前、末次随访时采用上肢功能评分(DASH)、Neer肩关节功能评分、Mayo肘关节功能评分(MEPS)评价肩关节功能、肘关节功能。结果39例患者术后获(13.8±3.5)个月随访,手术时间为(84.3±7.3)min,术中出血量为(127.5±4.5)mL,骨折愈合时间(24.4±1.3)周,骨折愈合率达100%(39/39)。所有患者术后无感染、神经血管损伤、内固定再次断裂等并发症发生。末次随访时DASH评分[(7.4±1.2)分]、Neer肩关节功能评分[(93.4±5.2)分]、MEPS[(94.6±3.3)分]均较术前[(26.6±8.4)、(74.3±6.5)、(73.8±5.3)分]显著改善,差异均有统计学意义(P<0.05)。末次随访时患者前屈上举活动度为168.5°±3.4°,外展上举为167.5°±5.2°,水平前屈129.5°±11.8°。结论"通道成骨"技术结合双钢板治疗非感染性肱骨干骨折术后骨不连可获得满意临床效果,值得临床应用。ObjectiveTo investigate the clinical efficacy of the bone-forming channel technique combined with double plates in the treatment of postoperative aseptic nonunion of the humeral shaft.MethodsA retrospective study was conducted to analyze the data of 39 patients with postoperative aseptic nonunion of the humeral shaft who had been treated by bone-forming channel technique combined with double plates from March 2018 to December 2022.There were 20 males and 19 females,with an age of(46.5±1.6)years.The bone nonunion was atrophic in 18 cases and hypertrophic in 21 cases.The operation time,intraoperative bleeding,fracture healing time and complications were recorded.The shoulder and elbow functions were evaluated before operation and at the final follow-up using the Disabilities of the Arm,Shoulder and Hand(DASH)score,Neer's shoulder function score,and Mayo's elbow performance score(MEPS).ResultsAll the 39 patients were followed up for an average duration of(13.8±3.5)months.The operation time was(84.3±7.3)minutes,the intraoperative bleeding(127.5±4.5)mL,the fracture healing time(24.4±1.3)weeks,and the fracture healing rate 100%(39/39).None of the patients had such postoperative complications as infection,neurovascular injury,or re-rupture of internal fixation.At the final follow-up,the patients'DASH score[(7.4±1.2)points],Neer's shoulder function score[(93.4±5.2)points],and MEPS[(94.6±3.3)points]were significantly improved compared respectively with the preoperative values[(26.6±8.4)points,(74.3±6.5)points,and(73.8±5.3)points](P<0.05).At the final follow-up,the patients'forward flexion and upward mobility was 168.5°±3.4°,abduction and upward mobility was 167.5°±5.2°,and horizontal forward flexion was 129.5°±11.8°.ConclusionIn the treatment of postoperative aseptic nonunion of the humeral shaft,since the bone-forming channel technique combined with double plates can achieve satisfactory clinical outcomes,it is worthy of clinical application.

关 键 词：肱骨骨折 骨折 不愈合 髂骨 骨移植 内固定器 

分 类 号：R687.3[医药卫生—骨科学]