Pollon Tristan, Reina Nicolas, Delclaux Stéphanie, Bonnevialle Paul, Mansat Pierre, Bonnevialle Nicolas
Orthopaedic, University Hospital, Place Baylac, Toulouse, 31059, France.
Int Orthop. 2017 Feb;41(2):367-373. doi: 10.1007/s00264-016-3267-3. Epub 2016 Aug 10.
Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union treated with plating and bone grafting. The secondary objective was to expose factors contributing to the failure of prior bone union attempts.
Sixteen patients (average age of 52 years) were treated for persistent non-union of the humeral shaft in our department; six of these patients had predisposing comorbidities or addictions. The persistent non-union was treated by plating with autologous bone graft from the iliac crest in a single-stage procedure in 12 cases and a two-stage procedure in three cases; one case was treated with plating and vascularized fibula graft.
At a minimum follow-up of 12 months (average 78 months), four (25 %) failed to heal. The 12 other patients had bone union after an average of eight months. The average QuickDASH score was 48 points (18-72). A retrospective analysis of the prior attempts to treat the non-union revealed three cases of unstable fixation, four cases with no osteogenic supply and seven cases of positive microbiological cultures at the non-union site.
Plating and autologous bone grafting resulted in union in only 75 % of persistent non-union of the humeral shaft. The persistent nature of the humeral shaft non-union could be attributed to deviating from validated rules for surgical treatment and/or the presence of a surgical site infection.
肱骨干持续性骨不连的手术治疗是一种复杂的情况，因为存在手术失败及与手术相关并发症的风险。本研究的主要目的是评估一系列采用钢板固定及植骨治疗的持续性骨不连患者的临床和影像学结果。次要目的是揭示导致先前骨愈合尝试失败的因素。
我科对16例肱骨干持续性骨不连患者进行了治疗（平均年龄52岁）；其中6例患者有诱发合并症或成瘾问题。12例患者采用单阶段手术，使用取自髂嵴的自体骨移植并结合钢板固定治疗持续性骨不连，3例采用两阶段手术；1例采用钢板固定及带血管腓骨移植治疗。
在至少12个月（平均78个月）的随访中，4例（25%）未愈合。其余12例患者平均8个月后实现骨愈合。平均QuickDASH评分为48分（18 - 72分）。对先前治疗骨不连尝试的回顾性分析显示，有3例固定不稳定，4例无成骨供应，7例骨不连部位微生物培养呈阳性。
钢板固定及自体骨移植仅使75%的肱骨干持续性骨不连实现了愈合。肱骨干骨不连的持续性可能归因于偏离了已验证的手术治疗规则和/或存在手术部位感染。
