肱骨交锁髓内钉治疗肱骨骨折术后骨不连

Treatment of nonunion of humeral fractures with interlocking intramedullary nailing

目的介绍应用肱骨交锁髓内钉治疗肱骨骨折术后骨不连的经验。方法1997年10月～2001年7月,应用肱骨交锁髓内钉治疗12例肱骨骨折术后骨不连患者,其中肥大型5例,萎缩型2例,假关节形成5例。受伤至骨不连手术的时间平均为10．5个月(5～33个月)。手术采用开放复位顺行置入髓内钉,锁入远端交锁钉后向近端打拔以使断端加压,自体髂骨及RBX植骨。结果所有患者获平均21个月(9～51个月)随访。12例患者骨不连均获得愈合,平均愈合时间为5．8个月(3．5～8．0个月)。其中1例去除髓内钉后1年于原骨不连部位发生再骨折,重新植骨内固定而获得愈合。11例肩关节及上肢功能恢复良好。所有患者未遗留神经损伤症状。结论肱骨交锁髓内钉为治疗肱骨骨折术后骨不连的有效方法。

Objective To report our experience in treatment of nonunion of humeral fractures using humeral interlocking intramedullary nailing. Methods Twelve patients of nonunion of humeral fractures were treated with humeral interlocking intramedullary nailing from October 1997 to July 2001. Five cases were hypertrophic, two were atrophic, and five had pseudoarticulation formation. The delayed time from injury to surgery for nonunion averaged 10. 5 months （range, 5 to 33 months）. Open nailing was performed through the antegrade approach. Axial compression was specially applied onto the fracture site with a humeral nail holder after insertion of distal locked screws. Autogenous iliac bone and RBX grafting was performed. Results The average follow-up time was 21 months （range, 9 to 51 months） . All patients achieved osseous union in, on average, 5.8 months （range, 3.5 to 8.0 months）. Refracture of the original nonunion region happened in one patient after removal of the internal fixation one year later, in whom union was achieved again after another internal fixation combined with bone grafting. Eleven patients had good functions of shoulder joint and upper extremity. No patient experienced any permanent neurological deficit. Conclusion Humeral interlocking intramedullary nailing is an effective alternative for humeral nonunion.