皮质剥脱术联合皮质外骨桥技术治疗肱骨干骨折术后萎缩型骨不连

Osteoperiosteal decortication and extracortical bone-bridging for treatment of atrophic humeral nonunions

目的探讨皮质剥脱术联合皮质外骨桥技术治疗肱骨干骨折术后萎缩型骨不连的临床疗效。方法回顾性分析2008年3月至2016年4月采用皮质剥脱术联合皮质外骨桥技术治疗19例肱骨干骨折术后萎缩型骨不连患者资料。男12例，女7例；年龄23～68岁，平均36．6岁；左侧10例，右侧9例。受伤至本次入院前接受手术治疗1次有8例，2次有6例，3次有5例。受伤至本次入院时间为12～106个月，平均26．3个月。末次随访时参照Neer肩关节评分标准和Mayo肘关节功能评分（MEPS）评价肩、肘关节功能。结果术后切口均一期愈合，2例患者出现桡神经损伤症状。19例患者术后获13～78个月（平均28．9个月）随访。放射学结果显示术后6～8周移植骨板在断端开始骨重建，骨折线模糊，皮质外骨桥逐渐形成。19例患者骨不连均获愈合，无畸形愈合，愈合时间10～46周，平均16．8周。末次随访时Neer肩关节功能评分为70～98分（平均82．5分），其中优12例，良5例，可2例；MEPS评分为70～96分（平均84．4分），其中优11例，良5例，可3例。结论采用皮质剥脱术联合皮质外骨桥技术治疗肱骨干骨折术后萎缩型骨不连既能有效诱导成骨，又能够增加断端稳定性，可促进骨愈合。

Objective To assess the effectiveness of osteoperiosteal decortication and extracortical bone-bridging in the treatment of atrophic humeral nonunions. Methods Nineteen patients with atrophic humeral nonuninon were treated by osteoperiosteal decortication and extraeortical bone-bridging between March 2008 and April 2016. They were 12 men and 7 women, aged from 23 to 68 years （mean, 36. 6 years）. The fracture was located at the left side in 10 cases and at the right side in 9. Before admission to our hospital, 8 had received surgery once, 6 twice and 5 thrice. The time from fracture to hospitalization ranged from 12 to 106 months （average, 26.3 months）. Shoulder function was evaluated by Neer scoring and elbow function by Mayo elbow performance score （MEPS） at final follow-ups. Results All incisions healed by first intention. Two cases reported transient radial nerve symptoms of numbness. All the 19 patients were followed up for 28.9 months on average （range, from 13 to 78 months） . Radiographic examinations showed signs of bone remodeling, dis- appearance of fracture lines and formation of extracortical bone bridge at 6 to 8 weeks after operation. All of them achieved radiographic union within 10 to 46 weeks （16. 8 weeks on average） . The Neer scores averaged 82.5 （range, from 70 to 98）, giving 12 excellent cases, 5 good ones and 2 fair ones. The MEPS averaged 84.4 （range, from 70 to 96）, giving 11 excellent cases, 5 good ones and 3 fair ones. Conclusion Osteope- riosteal decortication and extracortical bone-bridging in treatment of atrophic humeral nonunions can effectively induce osteogenesis and increase stability of broken ends, promoting bone healing.