Khan Mohammad Shoaib, Sahibzada Ahmed Sohail, Khan Mohammad Ayaz, Sultan Shahid, Younas Mohammed, Khan Alam Zeb
Department of Orthopaedics, Ayub Medical College & Hospital Abbottabad, Pakistan.
J Ayub Med Coll Abbottabad. 2005 Apr-Jun;17(2):44-6.
Humeral diaphyseal fracture usually heals with closed methods but when non union develops then it needs surgical intervention in the form of plating and bone grafting, intramedulary nailing (open or closed simple or interlocking nails) and external fixators (circular or one plane fixator). In our unit we treated non union humeral diaphyseal fracture with plating and bone grafting and shortening of fracture ends up to 4 to 5 cm when needed.
This study was conducted at Orthopaedic Department of Ayub Teaching Hospital Abbottabad from January 2002 till December 2003. We included 15 cases with atrophic non-union in 9 (60%) and hypertrophic non-union in 6 (40%) patients. All atrophic non-union were treated with plating, bone shortening by transverse osteotomy and bone grafting, while hypertrophic non-union were treated with decortications of non-union ends and fixation with compression plates, with bone grafting in old age. Follow up measures were based on clinical (range of joints motion) and radiological (healing) findings. Follow up was done for up to 6 months.
Out of 15 patients the age range was 20-80 years, 12 (80%) were male and 03 (20%) female. Right humerus involved in 5 (33.33%) while left humerus in 10 (66.66%) patients. In 9 (60%) patients with atrophic non union bone shortening by transverse cut osteotomy was done while in remaining patients with hypertrophic non-union plating was done in 2 (13.33%) cases and plating with bone grafting in 4 (26.66%) patients. Union was achieved in all patients after 16 to 20 weeks of surgery. In one patient (6.66%) of 75 years age with hypertrophic non-union implant was loosened after 03 months of surgery. At that time healing (Union) was evident on X-rays and humeral brace was applied for further 03 months. Two patients (13.33%) got neuropraxia of radial nerve which resolved with in 3 months time. 02 patients (13.33%) developed shoulder stiffness which resolved after exercise.
In Non Union of Humerus shortening by transverse osteotomy & rigid fixation with plates give excellent results in selected cases.
肱骨干骨折通常采用闭合方法愈合，但当发生骨不连时，则需要采取手术干预，形式包括钢板固定及植骨、髓内钉固定（开放或闭合，简单或带锁髓内钉）以及外固定架（环形或单平面固定架）。在我们科室，对于肱骨干骨不连，我们采用钢板固定及植骨，并在必要时将骨折端缩短4至5厘米进行治疗。
本研究于2002年1月至2003年12月在阿伯塔巴德阿尤布教学医院骨科开展。我们纳入了15例骨不连患者，其中9例（60%）为萎缩性骨不连，6例（40%）为肥大性骨不连。所有萎缩性骨不连患者均采用钢板固定、经横行截骨缩短骨骼及植骨治疗，而肥大性骨不连患者，对于不连端进行去皮质处理并使用加压钢板固定，老年患者同时进行植骨。随访措施基于临床（关节活动范围）和影像学（愈合情况）检查结果。随访时间长达6个月。
15例患者年龄范围为20至80岁，12例（80%）为男性，3例（20%）为女性。右侧肱骨受累5例（33.33%），左侧肱骨受累10例（66.66%）。9例（60%）萎缩性骨不连患者采用经横行截骨缩短骨骼治疗，其余肥大性骨不连患者中，2例（13.33%）采用钢板固定，4例（26.66%）采用钢板固定并植骨。所有患者术后16至20周均实现骨愈合。1例75岁肥大性骨不连患者术后3个月出现植入物松动。当时X线显示有愈合迹象，之后使用肱骨支具再固定3个月。2例患者（13.33%）出现桡神经失用，3个月内恢复。2例患者（13.33%）出现肩关节僵硬，经锻炼后恢复。
对于肱骨骨不连，经横行截骨缩短骨骼并使用钢板坚强固定，在部分病例中可取得良好效果。
