Department of Orthopaedic Surgery, National Police Hospital, Seoul, South Korea.
Department of Orthopaedic Surgery, Korean Armed Forces Capital Hospital, Seongnam, South Korea.
Eur J Orthop Surg Traumatol. 2022 Jan;32(1):159-165. doi: 10.1007/s00590-021-02904-6. Epub 2021 Mar 25.
This study evaluated the clinical and radiological results of plate osteosynthesis with autologous cortical and cancellous bone graft for nonunion of midshaft clavicle fracture.
A retrospective review was performed for all patients who underwent surgery for midshaft clavicle nonunion at a Level I trauma center. Visual analog scales (VAS) for pain and Quick-DASH (Disabilities of Arm, Shoulder, and Hand) score were assessed. Bone union rate, change in length of affected clavicle, complications, and reoperation were determined. Risk factors were identified to determine the effect on the healing.
Thirty-four patients were included for analysis. All patients achieved solid bone union at mean 16 weeks (range 8-36) after surgery. The mean shortening of affected clavicle decreased significantly postoperatively (P < 0.001). There was significant improvement in both pain VAS and Quick-DASH score (P < 0.001). There was no wound complication, infection, or major neurovascular injury. Ten patients (29%) complained of plate irritation and underwent removal of implant without any subsequent adverse event. Multiple regression analysis demonstrated that high-energy trauma and previous surgery were the independent risk factors that significantly delayed time to union (P < 0.05).
Osteosynthesis with autologous dual bone graft for nonunion of midshaft clavicle produced an excellent union rate with good clinical outcome and minimal complications.
本研究评估了采用自体皮质骨和松质骨移植治疗锁骨中段骨折不愈合的临床和影像学结果。
回顾性分析了在一级创伤中心接受锁骨中段不愈合手术的所有患者。评估了疼痛的视觉模拟量表（VAS）和快速残疾评估（Disabilities of Arm, Shoulder, and Hand，DASH）评分。确定了骨愈合率、受累锁骨长度的变化、并发症和再次手术的情况。确定了风险因素以确定其对愈合的影响。
34 名患者纳入分析。所有患者术后平均 16 周（8-36 周）达到了坚实的骨愈合。受累锁骨的缩短在术后显著减少（P<0.001）。疼痛 VAS 和快速 DASH 评分均有显著改善（P<0.001）。无伤口并发症、感染或主要的神经血管损伤。10 名患者（29%）抱怨钢板刺激，并在没有任何后续不良事件的情况下取出了植入物。多因素回归分析表明，高能量创伤和先前的手术是显著延迟愈合时间的独立危险因素（P<0.05）。
采用自体双骨移植治疗锁骨中段骨折不愈合，具有较高的愈合率、良好的临床效果和较低的并发症发生率。
