Department of Orthopedic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Curr Med Sci. 2019 Jun;39(3):426-430. doi: 10.1007/s11596-019-2054-y. Epub 2019 Jun 17.
Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up (F=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.
骨折对线的恢复对于肱骨干骨折不愈合的治疗至关重要。在本研究中,我们介绍了一种新的截骨方法(Z 形),用于治疗因钢板内固定失败导致的肱骨干骨折不愈合。回顾性分析 2010 年至 2014 年间 24 例因植入物失败(初次手术后)导致肱骨干骨折不愈合的患者的临床资料。这些患者在初次手术后的翻修手术中接受了 Z 形截骨术和钢板内固定术。采用视觉模拟评分(VAS)和 Constant 和 Murley 评分评估疗效。采用重复方差分析(ANOVA)进行统计学分析。患者的随访时间至少为 24 个月(26.83±4.33 个月)。手术时间为 102.33±10.16 分钟,平均住院时间为 9.75±2.13 天。所有患者均在末次随访时达到临床愈合。并发症包括桡神经麻痹(n=1)和浅表伤口感染(n=1)。与术前相比,术后 VAS 评分显著降低(F=257.99,P<0.01)。Constant 和 Murley 评分增加,在 24 个月的随访时达到 81.33±0.95(F=247.35,P<0.01)。所有病例中,15 例评为“优”,9 例评为“良”。总之,Z 形截骨术操作简单,提供了更多的内侧支撑和更大的骨接触面积。采用锁定钢板和 Z 形截骨术进行翻修手术,可获得较高的愈合率和改善功能结局。对于治疗因植入物失败导致的肱骨干骨折不愈合,这是一种合理且安全的选择。