Großner T, Schmidmaier G
Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Klinik für Orthopädie und Unfallchirurgie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland.
Unfallchirurg. 2020 Sep;123(9):705-710. doi: 10.1007/s00113-020-00851-1.
Non-unions occur in 5-10% of all fractures, whereby there is a large variability in the rate with respect to the anatomical location. All non-unions have in common that without any further medical treatment no healing can be expected, independent of the time. There is a wide range of surgical approaches for treatment of these extremely complex pathological situations, which are successful in 75-85% of the cases. Besides surgical approaches there are various conservative treatment options, which should be considered in every treatment planning. Vital non-unions sometimes shows a very good response to noninvasive procedures, particularly in the early stages.
Healing can be achieved even by using basic medical measures, such as optimization of comorbidities, reduction of risk factors and conditioning of an extremity. More elaborate procedures, such as low-intensity pulsed ultrasound (LIPUS) or extracorporeal shockwave therapy (EWST) can make surgical treatment superfluous in 63-94% of cases and show no or only very few side effects at a much lower cost; however, a high patient compliance level is necessary when performing these procedures. As optimal preconditions for a successful conservative treatment, non-unions should be stable due to an adequate osteosynthesis and free of infections, should not show any malalignment and the defect area should be less than 5 mm.
In every individual case an experience physician should determine whether a conservative treatment option is possible for this complex condition.
骨不连在所有骨折中发生率为5% - 10%，且在不同解剖部位发生率差异很大。所有骨不连的共同之处在于，无论时间如何，若不进行进一步治疗，骨折都无法愈合。治疗这些极其复杂的病理情况有多种手术方法，成功率在75% - 85%。除手术方法外，还有各种保守治疗方案，在每个治疗计划中都应予以考虑。有活力的骨不连有时对非侵入性治疗反应良好，尤其是在早期阶段。
即使采用基本医疗措施，如优化合并症、降低危险因素和对肢体进行功能训练，也能实现愈合。更精细的治疗方法，如低强度脉冲超声（LIPUS）或体外冲击波疗法（EWST），在63% - 94%的病例中可使手术治疗变得不必要，且副作用极少或几乎没有，成本也低得多；然而，进行这些治疗时患者的依从性要高。作为成功保守治疗的最佳前提条件，骨不连应因充分的骨合成而稳定且无感染，不应有任何畸形，缺损区域应小于5毫米。
在每个具体病例中，经验丰富的医生应确定这种复杂情况是否可行保守治疗方案。
