肱骨上段骨折不愈合的手术治疗

SURGICAL TREATMENT OF UPPER HUMERUS FRACTURE NONUNION

目的探讨不同手术方式治疗肱骨上段骨折不愈合的临床疗效。方法 2001年5月-2007年9月,收治43例肱骨上段骨折不愈合患者。男31例,女12例;年龄20～57岁,平均37岁。致伤原因:车祸伤14例,高处坠落伤11例,跌伤7例,重物砸伤6例,机器伤4例,病理性损伤1例。经切开复位内固定手术1次者12例,2次者27例,3次者3例,4次者1例。骨折至该次入院时间10～52个月,平均23个月。于切开复位后,分别采用植骨加锁定加压钢板内固定术(9例)、肩胛骨瓣旋转移位加锁定加压钢板内固定术(15例)、肩胛骨瓣旋转移位、锁定加压钢板加胫骨骨板内固定术(19例)治疗。结果术后切口均Ⅰ期愈合,X线片示骨折对位、对线良好,无感染及神经损伤症状发生。43例均获随访,随访时间12～25个月,平均18个月。骨折均达骨性愈合,愈合时间3.0～7.5个月,平均4.9个月。根据X线片及肩、肘关节功能综合评定标准:优21例,良15例,可4例,差3例,优良率83.7%。结论对于肱骨上段骨折不愈合,锁定加压钢板可提供稳定的固定;同时根据断端情况选择合适植骨方法 ,均能取得满意效果。但对于多次手术或术后长期不愈合、断端骨质条件差者,切开复位、肩胛骨瓣旋转移位、锁定加压钢板加胫骨骨板内固定术可取得较好疗效。

Objective To explore the clinical effects of different operative procedures in treatment of upper humerus fracture nonunion.Methods From May 2001 to September 2007,43 cases of upper humerus fractures nonunion were treated,including 31 males and 12 females with an average age of 37 years（range,20-57 years）.The causes were traffic accident injury in 14 cases,falling injury from height in 11 cases,tumbling injury in 7 cases,heavy pound injury in 6 cases,machine injury in 4 cases,and pathological injury in 1 case.The time from fracture to hospitalization was 10-52 months（23 months on average）.After open reduction,patients were treated respectively by bone-graft plus locking compression plate fixation（9 cases）,scapula flap rotation displacement plus locking compression plate fixation（15 cases）,and scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation（19 cases）.Results All incisions healed by first intention.The X-ray films showed good fracture reduction.No symptoms of infection and nerve injury occurred.Forty-three patients were followed up 12 to 25 months with an average of 18 months.All of them achieved radiographic union within 3.0 to 7.5 months（4.9 months on average）.According to comprehensive assessing standard of X-ray film and functions of shoulder and elbow,the results were excellent in 21 cases,good in 15 cases,fair in 4 cases,and poor in 3 cases;the excellent and good rate was 83.7%.Conclusion In the treatment of upper humerus fractures nonunion,locking compression plate can provide stable fixation.It can achieve satisfactory results so long as the right method of bone graft is chosen according to fracture site situation.But for patients undergoing repeated surgery or having nonunion for long times and poor fracture site situation,after open reduction,scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation has good outcome.