Micic Ivan Dragoljub, Mitkovic Milorad Borivoje, Mladenovic Desimir Svetomir, Golubovic Velimir Zoran, Jeon In-Ho
Clinic for Orthopaedic Surgery and Traumatology, Clinical Center, Nis, Serbia.
J Trauma. 2008 May;64(5):1290-6. doi: 10.1097/TA.0b013e3180582471.
Although the use of a plate and bone graft is described as a well-known treatment for aseptic humeral shaft nonunion, unilateral external fixator can be alternative as a minimally invasive method. There has been no report comparing two methods of plate and external fixator for humeral shaft nonunion. Also, a few studies described humeral shaft aseptic nonunion treatment using unilateral external fixator.
We retrospectively reviewed 31 patients (15 men and 16 women) with aseptic humeral shaft nonunion treated by plate (n = 20) and unilateral external fixator (n = 11). Patients were followed for a mean of 31.8 months. The right upper arm was involved in 19 patients (17 dominant) and left in 12 patients (2 dominant). The inclusion criteria were aseptic, middle shaft nonunion, without bone defects more than 2 cm. Four patients had hypertrophic, and 27 patients had atrophic nonunion.
Solid union, as documented on plain radiographic views, was obtained in 28 (90.3%) patients without additional operation. The average operative time was 92.8 minutes in plate group and 47.8 minutes in external fixator group (p < 0.05). The average blood loss was 142.5 mL in plate group and it was 45.5 mL in external fixator group (p < 0.05). Average hospital stay was 10.9 days in plate group and 3.9 days for external fixator group (p < 0.05). Overall, healing time in the plate group was 4.4 months, compared with 3.6 months in the external fixation group (p < 0.05). The mean Constant and Murley score for plate group was 85.6 points and it was 74.3 points for the external fixator group. According to Stewart and Hundley criteria, 16 (80%) patients in the plate group and 6 (54.5%) patients in the external fixator group had good outcome. Two-pin track infection of the external fixator (18.2%) and two transient radial nerve palsy (10%) were recorded.
In this retrospective study of the humeral shaft nonunion, unilateral external fixator tended to yield equally favorable treatment results as did plate fixation. Advantages of the plate are good stability on the nonunion site and comfortability for patient. On the contrary, the advantages of the unilateral external fixator are minimal exposure to the nonunion site with minimal surgical trauma to the soft tissue, easy application of the fixator and consecutively minimal blood loss and short operative time. Unilateral external fixator could be a valuable alternative to plate fixation in aseptic humeral shaft nonunions.
尽管使用钢板和骨移植被描述为治疗无菌性肱骨干骨不连的一种常用方法，但单侧外固定架作为一种微创方法也可作为替代方案。目前尚无比较钢板和外固定架两种治疗肱骨干骨不连方法的报告。此外，也仅有少数研究描述了使用单侧外固定架治疗肱骨干无菌性骨不连。
我们回顾性分析了31例无菌性肱骨干骨不连患者（15例男性和16例女性），其中20例采用钢板治疗，11例采用单侧外固定架治疗。患者平均随访31.8个月。19例患者（17例优势侧）右侧上臂受累，12例患者（2例优势侧）左侧上臂受累。纳入标准为无菌性、中段骨不连，骨缺损不超过2cm。4例为肥大性骨不连，27例为萎缩性骨不连。
28例（90.3%）患者在未进行额外手术的情况下通过X线平片证实获得了牢固愈合。钢板组平均手术时间为92.8分钟，外固定架组为47.8分钟（p<0.05）。钢板组平均失血量为142.5mL，外固定架组为45.5mL（p<0.05）。钢板组平均住院时间为10.9天，外固定架组为3.9天（p<0.05）。总体而言，钢板组愈合时间为4.4个月，外固定组为3.6个月（p<0.05）。钢板组Constant和Murley平均评分为85.6分，外固定架组为74.3分。根据Stewart和Hundley标准，钢板组16例（80%）患者和外固定架组6例（54.5%）患者预后良好。记录到外固定架有2例针道感染（18.2%）和2例短暂性桡神经麻痹（10%）。
在这项关于肱骨干骨不连的回顾性研究中，单侧外固定架的治疗效果与钢板固定相当。钢板的优点是在骨不连部位稳定性好，患者舒适度高。相反，单侧外固定架的优点是对骨不连部位暴露最小，对软组织手术创伤最小，固定器易于应用，进而失血量最少且手术时间短。单侧外固定架可作为治疗无菌性肱骨干骨不连的一种有价值的替代钢板固定的方法。
