锁定加压钢板治疗肱骨干无菌性骨不连的疗效观察

EFFECTIVENESS OF LOCKING COMPRESS PLATE FOR TREATMENT OF ASEPTIC DIAPHYSEAL HUMERAL NONUNIONS

目的 探讨锁定加压钢板（locking compress plate,LCP）治疗肱骨干无菌性骨不连的疗效。方法2006年1月-2012年1月,收治23例肱骨干无菌性骨不连患者,采用LCP联合自体骨移植治疗。男15例,女8例;年龄28-60岁,平均42.5岁。左侧11例,右侧12例。致伤原因：交通事故伤15例,摔伤8例。骨折后行内固定20例,外固定3例。骨不连根据Weber-Cech分型标准：萎缩型6例,增生型17例。术后采用ConstantMurley肩关节评分和Mayo肘关节评分标准评价肩、肘关节功能。结果 术后出现桡神经不全麻痹2例,浅表性感染1例,均经对症处理后愈合;其余患者切口均Ⅰ期愈合,无早期相关并发症发生。患者均获随访,随访时间16-30个月,平均22.22个月。X线片复查示骨折均愈合,愈合时间12-24周,平均16.95周。11例肩关节活动度恢复正常;12例遗留不同程度肩关节外展、上举及后伸功能受限。末次随访时,Constant-Murley肩关节评分为50-98分,平均81.87分;优14例,良6例,可3例。Mayo肘关节评分为70-96分,平均87.78分;优14例,良7例,可2例。结论 LCP治疗肱骨干无菌性骨不连安全、有效,术中联合自体骨植骨有利于骨愈合。

Objective To evaluate the effectiveness of locking compress plate （LCP） for the treatment of aseptic diaphyseal humeral nonunions. Methods Between January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years （range, 28-60 years）. The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. Results After operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average （range, 16-30 months）. Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks （range, 12-24 weeks）. The average Constant-Murley score was 81.87 （range, 50-98）; and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 （range, 70-96）; and the result was excellent in 14 cases, good in 7, and fair in 2. Conclusion Aseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.