Flinkkilä T, Ristiniemi J, Hämäläinen M
Department of Surgery, Division of Orthopaedic and Trauma Surgery, University Hospital, Oulu, Finland.
J Trauma. 2001 Mar;50(3):540-4. doi: 10.1097/00005373-200103000-00021.
To assess results of exchange nailing in nonunion after intramedullary (IM) nailing of humeral shaft fractures.
This was a retrospective study; 24 patients with nonunion after IM nailing of humeral shaft fractures were reviewed. In 13 cases, nonunion was treated using exchange nailing, and 11 patients were treated nonoperatively. Union was assessed from radiographs. Shoulder joint symptoms and function were assessed after a mean 4.7 years' follow-up using Constant-Murley scoring and self-administered questionnaires devised by L'Insalata et al.
Single or repeated exchange nailing resulted in union in 6 of 13 patients. Shoulder joint function was satisfactory (mean Constant-Murley score of 72) for those patients whose fracture eventually united and poor (mean Constant-Murley score of 39) for those left with nonunion.
Exchange nailing results in a poor union rate in nonunion after IM nailing of humeral shaft fractures. Permanent nonunion of the humeral shaft leaves the patient with severe disability.
评估肱骨干骨折髓内钉固定术后骨不连行交锁髓内钉治疗的效果。
本研究为回顾性研究；对24例肱骨干骨折髓内钉固定术后骨不连患者进行了分析。其中13例采用交锁髓内钉治疗骨不连，11例采用非手术治疗。通过X线片评估骨愈合情况。平均随访4.7年后，采用Constant-Murley评分和L'Insalata等人设计的自填式问卷评估肩关节症状和功能。
13例患者中，6例经单次或多次交锁髓内钉治疗后实现骨愈合。骨折最终愈合的患者肩关节功能良好（Constant-Murley评分平均为72分），而骨不连患者肩关节功能较差（Constant-Murley评分平均为39分）。
肱骨干骨折髓内钉固定术后骨不连行交锁髓内钉治疗的骨愈合率较低。肱骨干永久性骨不连会导致患者严重残疾。
