Faraud A, Bonnevialle N, Allavena C, Nouaille Degorce H, Bonnevialle P, Mansat P
Unité d'Orthopédie et Traumatologie de Purpan, Institut de l'appareil locomoteur, CHU de Toulouse, place du Dr-Baylac, 31059 Toulouse, France.
Unité d'Orthopédie et Traumatologie de Purpan, Institut de l'appareil locomoteur, CHU de Toulouse, place du Dr-Baylac, 31059 Toulouse, France.
Orthop Traumatol Surg Res. 2014 Apr;100(2):171-6. doi: 10.1016/j.otsr.2013.09.011. Epub 2014 Feb 15.
The aim of our study was to evaluate the results of surgical treatment of clavicle non-union after failure of conservative treatment. Our hypothesis was that stable fixation with bone graft derived from local bone stock (fracture site) or the iliac crest was essential to achieve bone union.
Twenty-one patients with a symptomatic middle-third clavicle non-union after failure of initial conservative treatment were included in the study. Delay between the initial fracture and surgery for non-union was 27 months (6-144). In five cases, the non-union was hypertrophic and bone graft was obtained locally from the callus. In 16 patients, the non-union was atrophic. Bone was harvested from the iliac crest as cortico-cancellous graft (7 patients) and cancellous graft (8 patients). One patient refused bone grafting. A 3.5-mm plate with non-locking screws was placed anterior in 12 and superior in 9 patients.
At 41 months average follow-up (minimum of 12 months), 20 patients were available for review. Bone healing was obtained initially in 15 cases. Six complications required a revision procedure: 3 for infection and 3 for mechanical failure. At last follow-up, 19 patients were satisfied with the surgery. Average Constant score was 84±26 points (7-100), and Quick DASH score 17±22 points (0-91). Radiographic bone healing was obtained in 19 of the cases.
Treatment of middle-third clavicle non-union after initial failure of conservative treatment with stable fixation and bone graft is a reliable, well-suited and effective treatment. Our hypothesis was verified. Preoperative evaluation of appearance of the non-union X-rays can be used to determine the type of bone graft needed, but the final decision is often taken during surgery.
Level IV.
我们研究的目的是评估保守治疗失败后锁骨不愈合的手术治疗结果。我们的假设是，使用源自局部骨源（骨折部位）或髂嵴的骨移植进行稳定固定对于实现骨愈合至关重要。
本研究纳入了21例初次保守治疗失败后出现症状性中1/3锁骨不愈合的患者。初次骨折与不愈合手术之间的间隔为27个月（6 - 144个月）。5例为肥大性不愈合，骨移植取自局部骨痂。16例为萎缩性不愈合。7例患者取髂嵴皮质松质骨移植，8例患者取松质骨移植。1例患者拒绝骨移植。12例患者在前侧放置3.5毫米非锁定钢板，9例患者在上方放置。
平均随访41个月（最短12个月），20例患者可供复查。最初15例实现了骨愈合。6例并发症需要翻修手术：3例因感染，3例因机械故障。末次随访时，19例患者对手术满意。Constant平均评分为84±26分（7 - 100分），Quick DASH评分为17±22分（0 - 91分）。19例患者获得影像学骨愈合。
初次保守治疗失败后，采用稳定固定和骨移植治疗中1/3锁骨不愈合是一种可靠、合适且有效的治疗方法。我们的假设得到了验证。术前对不愈合X线表现的评估可用于确定所需骨移植的类型，但最终决定通常在手术中做出。
四级。
