Rollo Giuseppe, Vicenti Giovanni, Rotini Roberto, Abate Antonella, Colella Antonio, D'Arienzo Antonio, Carrozzo Massimiliano, Moretti Biagio
V. Fazzi Hospital, Lecce, Italy.
Department of Neuroscience and Organs of Sense, Orthopedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
Injury. 2017 Oct;48 Suppl 3:S60-S65. doi: 10.1016/S0020-1383(17)30660-5.
We investigated functional and radiological outcome in 57 cases of midshaft clavicle nonunion treated with open reduction and internal fixation with plate and screws over a 13 year-period. Intercalary bone graft was used in 42 patients; opposite autologous strut graft was used in 31 cases to provide mechanical support to the host bone. Patients were analysed using chart and radiological review and assessed with DASH questionnaire obtained at the latest follow-up. 37 patients were male while 20 were females, with a mean age of 35 years (63-17). All cases were of nonunion, 35 atrophic and 22 hypertrophic. The dominant side was injured in 32 cases and the non dominant in 25 cases. Primarily, 43 cases were treated conservatively with a figure of eight bandage. Time between fracture and our operative treatment was on average 44 months (13-72 months). Only those patients who were symptomatic were included in this study. We used straight reconstruction LCP and low profile precontoured plates. By reviewing patients charts all the cases but one of nonunion progressed to osseous healing at a mean time of 14 weeks (range 12-16). The patient with non-union refused further surgery. 49 patients were available for a final follow up. DASH score was 16.7 at an average of 42 months. Open surgery and internal fixation, using plate and screws in a compression construct is the treatment of choice for symptomatic clavicular non-unions. Intercalary autologous or allograft bone graft should be used especially in patient with significant bone loss; autologous cortical strut graft provides optimum mechanical stability, thus assuring optimal screw purchase and allowing immediate limb movement.
我们对57例中段锁骨骨不连患者进行了为期13年的研究，这些患者均接受了切开复位钢板螺钉内固定治疗。42例患者使用了嵌入性骨移植；31例使用了对侧自体支撑骨移植，以为主骨提供机械支撑。通过图表和影像学复查对患者进行分析，并使用最新随访时获得的DASH问卷进行评估。37例患者为男性，20例为女性，平均年龄35岁（63 - 17岁）。所有病例均为骨不连，其中35例为萎缩性，22例为肥大性。32例患侧为优势侧，25例为非优势侧。最初，43例患者接受了“8”字绷带保守治疗。骨折至我们手术治疗的平均时间为44个月（13 - 72个月）本研究仅纳入有症状的患者。我们使用了直形重建锁定加压钢板（LCP）和低轮廓预塑形钢板。通过查阅患者病历，除1例骨不连患者拒绝进一步手术外，其余所有骨不连病例均在平均14周（12 - 16周）时实现了骨愈合。49例患者可供最终随访。平均42个月时的DASH评分为16.7。对于有症状的锁骨骨不连，切开复位钢板螺钉加压内固定手术是首选治疗方法。对于有明显骨缺损的患者，应使用嵌入性自体或同种异体骨移植；自体皮质支撑骨移植可提供最佳的机械稳定性，从而确保最佳的螺钉把持力，并允许立即进行肢体活动。
