双钢板和自体骨植骨治疗非感染性肱骨干骨不愈合疗效分析.PDFVIP

浙江医学2017 年第39 卷第4 期 双钢板和自体骨植骨治疗非感 染性肱骨干骨不愈合疗效分析 张勇 庄云强 应霁翀 杨立峰 校佰平 马维虎 【摘要 】 目的 探讨双钢板和自体骨植骨治疗非感染性肱骨干骨折内固定术后骨不愈合疗效。方法 对 16 例非感染性肱 骨干骨折内固定术后骨不愈合患者，拆除原内固定、凿除增生骨痂、去除死骨，行双钢板固定和自体骨植骨治疗；术后行主、被动上 肢各关节运动。根据Mayo 肘关节功能评分及Constant-Murley 肩关节功能评分标准评价术后疗效。结果 16 例患者术后随访 12~26（14.5 ±6.8 ）个月，骨折均愈合良好，骨折愈合时间3~7（3.8 ±1.2 ）个月。1 例患者术后发生桡神经牵拉损伤，未作特殊处理，3 个 月后功能恢复；其他病例随访期间未见明显并发症。末次随访Mayo 肘关节功能评分：优 12 例，良3 例， 1 例；Constant-Murley 肩 关节功能评分：＞90 分 13 例，80~90 分3 例。结论 双钢板结合自体骨植骨治疗肱骨干非感染性骨不愈合，固定牢靠，疗效良好，值 得临床上采用。 【关键词】 骨不愈 肱骨干骨折 双钢板 自体骨植骨 Uninfected nonunion of the humeral shaft treated with dual-plate and autologous bone graft China 【Abstract 】 Objective To evaluate the clinical efficacy of dual plating combined with autologous bone grafts in treating uninfected nonunion of the humeral shaft fracture. Methods Clinical data of 16 cases of uninfected non-union of the humeral shaft fracture treated with dual-plate and autologous bone graft were analyzed retrospectively. During the procedure the hyperplasia of bone callus was removed, the sclerotic fracture was debrided, dual plates were fixed and the autogenous iliac bone was grafted. Patients were encouraged to move upper limb actively and passively to aggressive range immediately after operation.The postoperative function of upper extremity was evaluated according to the Mayo elbow joint function score and Constant-Murley shoulder function score standard. Results The mean follow-up period was 12-26 (14.5 ±6.8)months. The fractures were united in all patients after an average time of 3-7(3.8 ±1.2). One patient had radial nerve injury after surgery , who were recovered in 3 months without special treatment. Three months after surgery the functions of the shoulder, elbow and wrist of the operated limbs were all satisfactory. All cases achieved an excellent union without significant complicatio