异体皮质骨板结合髂骨植骨辅助钢板治疗肱骨干骨折骨不连的短期临床疗效

doi:10.3877/cma.j.issn.2096-0263.2023.03.004

目的

探究肱骨外侧锁定钢板+自体髂骨植骨+皮质骨骨板辅助钢缆捆绑固定治疗肱骨骨折骨不连的短期临床疗效。

方法

回顾性收集本院骨创病区2016年9月至2020年9月间接诊的肱骨术后骨不连的23例患者。男性15例，女性8例；平均年龄22~65（40.6±3.8）岁。骨不连均采用肱骨外侧锁定钢板+自体髂骨植骨+皮质骨骨板辅助钢缆捆绑固定治疗。肩肘功能随访，使用肩关节Neer评分以及Mayo肘关节功能评分（MEPS）系统。

结果

23例患者平均随访12~16（14.2±2.1）月。所有患者影像学表现均达到骨性愈合，且无肢体畸形改变；愈合时间平均为5~13（7.2±1.2）月。Neer肩关节功能在最后一次随访中的评分为72~96（84.5±8.2）分，优13例，良7例，中3例，优良率为86.9%；MEPS评分在最后一次随访中的评分为68~98（86.4±9.1）分，优15例，良6例，中2例，优良率为91.3%。

结论

采用肱骨外侧锁定钢板+自体髂骨植骨+皮质骨骨板辅助钢缆捆绑固定治疗肱骨骨不连，可实现肱骨的初始机械稳定，也可达到远期生物稳定；自体松质骨可有效诱导成骨，钢板与骨板结合增加了肱骨断端稳定性，实现了力学与生物学双方面的骨骼重建，使骨折愈合的几率大大增加。

关键词: 肱骨骨折, 骨不连, 异体骨板, 植骨

Objective

To explore the short-term clinical effect of lateral locking plate of humerus+autologous iliac bone graft+cortical bone plate assisted by steel cable binding fixation in the treatment of non-union of humeral fractures.

Methods

A retrospective analysis was conducted on 23 cases of postoperative nonunion of humeral fractures admitted from September 2016 to September 2020 in the bone trauma department of our hospital. 15 male patients and 8 female patients; The average age ranged from 22-65 (40.6±3.8) years. All cases of nonunion were treated with lateral locking plate of humerus, autologous iliac bone graft, and cortical bone plate assisted by steel cable binding and fixation. Shoulder and elbow function follow-up was conducted using the shoulder Neer score and the Mayo elbow function score (MEPS) system.

Results

23 patients were followed up for an average of 12-16 (14.2±2.1) months. The imaging findings of all patients achieved bony union, and there were no abnormal changes in the limbs; The average healing time was 5-13 (7.2±1.2) months. In the last follow-up, the score of Neer's shoulder joint function was 72-96 (84.5±8.2) points, with 13 excellent, 7 good, and 3 moderate. The excellent and good rate was 86.9%; The MEPS score at the last follow-up ranged from 68-98 (86.4±9.1) points, with 15 excellent, 6 good, and 2 moderate. The excellent and good rate was 91.3%.

Conclusions

The treatment of nonunion of humeral fractures with lateral locking plate of humerus, autologous iliac bone graft, and cortical bone plate assisted by steel cable binding fixation can achieve initial mechanical stability and long-term biological stability of the humerus; Autologous cancellous bone can effectively induce bone formation. The combination of steel plate and bone plate increases the stability of the broken end of the humerus, achieving both mechanical and biological bone reconstruction, and greatly increasing the probability of fracture healing.

Key words: Humeral fracture, Nonunion, Allogeneic bone plate, Bone graft

图1~12 男性，22岁，以"车祸致右上臂畸形伴疼痛1天"为主诉，急诊由外地转入我院，评估患者病情后给予患者行前外侧切开复位内固定手术治疗。图1~2　入院时X线片；图3~4　第一次术后X线片；图5~6 4月后患者摔倒后再次出现右上臂肿痛伴局部畸形改变，行X线片检查后考虑为：右侧肱骨骨折；右侧肱骨骨折术后螺钉断裂，于2019年6月再次给予患者右侧肱骨翻修手术；图7~8　翻修术后X线片；图9~10　翻修术后1年X线片；；图11~12　内固定取出术后X线片

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Short-term clinical efficacy of allogeneic cortical bone plate combined with iliac bone graft as an auxiliary plate in the treatment of nonunion of humeral shaft fractures

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Short-term clinical efficacy of allogeneic cortical bone plate combined with iliac bone graft as an auxiliary plate in the treatment of nonunion of humeral shaft fractures