Hierholzer Christian, Sama Domenico, Toro Jose B, Peterson Margaret, Helfet David L
Orthopaedic Trauma Service, Weill Medical College of Cornell University-Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
J Bone Joint Surg Am. 2006 Jul;88(7):1442-7. doi: 10.2106/JBJS.E.00332.
Delayed union or nonunion of a fracture of the humerus is an infrequent but debilitating complication. Open reduction and internal fixation combined with autologous bone-grafting can result in reliable healing of the fracture; however, there is morbidity associated with the bone-graft donor site. This study was designed to evaluate healing of ununited fractures of the humeral shaft treated by one surgeon at one institution with a strict and consistent surgical protocol but with the use of two different types of bone graft: autologous iliac crest bone graft and demineralized bone matrix.
A consecutive retrospective cohort series was analyzed. From 1992 to 1999, forty-five patients with an aseptic, atrophic delayed union or nonunion of a humeral shaft fracture were treated with open reduction and internal fixation with a plate and autologous iliac crest bone graft. The mean time from the fracture to the surgery was 14.0 months, and the mean duration of follow-up was 32.8 months. From 2000 to 2003, thirty-three patients with the same condition were treated with the same protocol with the exception that demineralized bone matrix was used instead of autologous iliac crest bone graft. The mean time from the fracture to the surgery in that group was 22.6 months, and the mean duration of follow-up was 20.4 months. All patients in both groups were assessed clinically and radiographically.
Osseous union was noted clinically and radiographically following the index surgery in 100% of the forty-five patients treated with autologous bone graft and 97% (thirty-two) of the thirty-three patients treated with demineralized bone matrix. The mean time to union was 4.5 months in the group treated with autologous bone graft and 4.2 months in the group treated with demineralized bone matrix. The overall functional outcome did not differ between the groups; however, twenty (44%) of the autologous bone-graft recipients had donor site morbidity, including a prolonged pain in the majority and a superficial infection requiring irrigation and débridement in one patient.
Healing of an ununited humeral shaft fracture can be achieved consistently with rigid plate fixation and lag-screw compression augmented with either autologous cancellous bone graft or commercially available demineralized bone matrix. The harvest of the autologous bone graft is frequently associated with complications.
Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
肱骨干骨折延迟愈合或不愈合是一种少见但会导致功能障碍的并发症。切开复位内固定联合自体骨移植可使骨折可靠愈合；然而，骨移植供区存在一定的并发症。本研究旨在评估在同一机构由同一位外科医生采用严格且一致的手术方案，但使用两种不同类型的骨移植材料（自体髂嵴骨移植和脱矿骨基质）治疗肱骨干不愈合骨折的愈合情况。
对一个连续的回顾性队列系列进行分析。1992年至1999年，45例肱骨干骨折无菌性、萎缩性延迟愈合或不愈合患者接受切开复位，用钢板内固定并植入自体髂嵴骨移植。骨折至手术的平均时间为14.0个月，平均随访时间为32.8个月。2000年至2003年，33例相同情况的患者接受相同方案治疗，不同的是使用脱矿骨基质替代自体髂嵴骨移植。该组骨折至手术的平均时间为22.6个月，平均随访时间为20.4个月。两组所有患者均进行临床和影像学评估。
接受自体骨移植治疗的45例患者中，100%在初次手术后临床和影像学检查显示骨愈合；接受脱矿骨基质治疗的33例患者中，97%（32例）显示骨愈合。自体骨移植组的平均愈合时间为4.5个月，脱矿骨基质组为4.2个月。两组的总体功能结果无差异；然而，20例（44%）接受自体骨移植的患者出现供区并发症，包括大多数患者有长期疼痛，1例患者发生浅表感染需要冲洗和清创。
采用坚强钢板固定和拉力螺钉加压，联合自体松质骨移植或市售脱矿骨基质，可使肱骨干不愈合骨折持续愈合。自体骨移植常伴有并发症。
治疗性III级。有关证据水平的完整描述见作者须知。
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