Babhulkar Sudhir, Babhulkar Sushrut, Vasudev Aditya
Department of Orthopedics, Sushrut Institute of Medical Sciences, Nagpur, India.
Department of Orthopedics, Sushrut Institute of Medical Sciences, Nagpur, India.
Injury. 2017 Aug;48 Suppl 2:S33-S43. doi: 10.1016/S0020-1383(17)30492-8.
Non-union of the humeral shaft is infrequently noticed after surgical fixation. Sixty eight patients whose osteosynthesis of humeral shaft had failed leading to non-union were identified over a duration of 10 years from (January 2006 to December 2015). Clinical and radiographical follow-up was available for 64 patients (4 patients were lost for follow-up), with a mean age of 58 years (range 25-78 years). All patients had aseptic atrophic non-union of either: proximal shaft (n=12), mid shaft (n=38), and lower shaft (n=14). All these patients had failure of primary fixation, with a minimum duration from 36 to 110 weeks. Non-unions were operated by excision of non-union, autogenous bone grafting and osteosynthesis by locking compression plating. Adequate fixation of non-union with bone grafting was achieved in all patients. All non-unions healed well at an average of 16 weeks (range 6-36 weeks). The mean length of follow-up was 120 weeks (range 60-250 weeks). The mean range of movements following healing of non-union was forward flexion of 140°, external rotation and internal rotation of 30° at shoulder and average fixed flexion deformity of 10° and flexion of 130° at elbow. Two patients had postoperative radial nerve palsy because of neuropraxia, which recovered in eight weeks. Three patient developed superficial infections at the iliac crest, which settled with antibiotics, dressings in 3 weeks time and two patients had some discomfort over the fibular graft harvest site. In all patients complete clinical and radiological union was achieved with satisfactory outcome in terms of relief of symptoms and functional improvement in the range of movements. The main points in surgical treatment were complete excision of non-union, correction of deformity, use of plenty of corticocancellous graft, furthermore the use of intramedullary fibula and osteosynthesis by long locking compression plating in different modes of fixation provided good to excellent results and clinical outcome.
肱骨干骨折手术固定后骨不连并不常见。在2006年1月至2015年12月的10年期间，共确定了68例肱骨干骨合成失败导致骨不连的患者。64例患者（4例失访）有临床和影像学随访资料，平均年龄58岁（范围25 - 78岁）。所有患者均为无菌性萎缩性骨不连，其中：近端骨干（n = 12）、中段骨干（n = 38）和下段骨干（n = 14）。所有这些患者初次固定均失败，最短持续时间为36至110周。骨不连通过骨不连切除、自体骨移植以及锁定加压钢板进行骨合成手术治疗。所有患者的骨不连均通过植骨获得了充分固定。所有骨不连平均在16周（范围6 - 36周）愈合良好。平均随访时间为120周（范围60 - 250周）。骨不连愈合后平均活动范围为：肩部前屈140°，外旋和内旋30°，肘部平均固定屈曲畸形10°，屈曲130°。2例患者因神经失用症出现术后桡神经麻痹，8周后恢复。3例患者在髂嵴处发生浅表感染，经抗生素治疗、换药3周后痊愈，2例患者在腓骨取骨部位有一些不适。所有患者均实现了完全的临床和影像学愈合，症状缓解和活动范围功能改善方面的结果令人满意。手术治疗的要点是完全切除骨不连、矫正畸形、使用大量皮质松质骨移植，此外，使用髓内腓骨以及通过不同固定方式的长锁定加压钢板进行骨合成，取得了良好至优异的效果和临床结果。
