Allende Christian, Vanoli Fernando, Gentile Luciano, Gutierrez Natalia
Instituto Allende de Cirugía Reconstructiva, Sanatorio Allende, Hipolito Yrigoyen 384, 5000, Córdoba, Argentina.
Int Orthop. 2018 Nov;42(11):2685-2689. doi: 10.1007/s00264-018-3911-1. Epub 2018 Mar 24.
The purpose of this study was to evaluate the results achieved after the use of lateral minimally invasive plate osteosynthesis (MIPO) in oligotrophic humerus nonunions resulting from failed intramedullary nailing (IM).
We evaluated nine patients with humerus nonunion after failed locked intramedullary nailing, all treated using 3.5-mm locked compression plates (LCP) placed through lateral minimally invasive approaches, between 2010 and 2016. Patient's age averaged 39.7 years. All nonunions were diaphyseal and oligotrophic. All nonunions had previous surgical treatment with static locked nails (seven antegrade and two retrograde). The IM nails were all well inserted in the humerus (none of them protruded or had rotator cuff lesions associated). Pre-operative Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 25.5 points. Pre-operative Constant's score averaged 80.2. Pre-operative visual analog scale of pain averaged 2.4 points.
Follow-up averaged 17.7 months. Time between initial surgery and revision procedure averaged 11.7 months. Union was achieved in all cases, after an average of 4.8 months. DASH score at last follow-up averaged 5.1 points, and final Constant's score averaged 93.7 points. The analog scale of pain averaged 0.7 points. Time from definitive surgery to work return averaged 3.9 months. Long 3.5-mm LCPs were used (plate length averaged 16.9 screw holes). In two cases, a third 4-cm incision at the nonunion site was performed and cancellous autologous iliac crest bone graft was associated.
In our series of nine patients, we achieved union and good objective and subjective results, with high patient satisfaction, using a lateral MIPO technique and placing long 3.5-mm LCPs in selected oligotrophic humerus nonunions after failed IM nailing.
本研究的目的是评估在髓内钉固定失败导致的营养不良性肱骨骨不连中采用外侧微创钢板接骨术（MIPO）后的治疗效果。
我们评估了2010年至2016年间9例锁定髓内钉固定失败后的肱骨骨不连患者，均采用经外侧微创入路置入3.5毫米锁定加压钢板（LCP）进行治疗。患者平均年龄为39.7岁。所有骨不连均位于骨干且为营养不良性。所有骨不连既往均接受过静态锁定髓内钉手术治疗（7例顺行髓内钉和2例逆行髓内钉）。髓内钉在肱骨内均置入良好（均未穿出或伴有肩袖损伤）。术前上肢、肩部和手部功能障碍（DASH）评分平均为25.5分。术前Constant评分平均为80.2分。术前视觉模拟疼痛评分平均为2.4分。
随访平均17.7个月。初次手术与翻修手术之间的时间平均为11.7个月。所有病例均在平均4.8个月后实现骨愈合。末次随访时DASH评分平均为5.1分，最终Constant评分平均为93.7分。疼痛模拟评分平均为0.7分。从确定性手术到恢复工作的时间平均为3.9个月。使用了长3.5毫米的LCP（钢板长度平均为16.9个螺孔）。2例患者在骨不连部位额外做了一个4厘米的切口，并联合自体髂骨松质骨移植。
在我们的9例患者系列中，采用外侧MIPO技术并在选定的髓内钉固定失败后的营养不良性肱骨骨不连中置入长3.5毫米的LCP，实现了骨愈合以及良好的客观和主观效果，患者满意度高。
