Grewal Simran, Baltes Thomas Pa, Wiegerinck Esther, Kloen Peter
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Department of Orthopaedic and Trauma Surgery, Tergooi Hospital, Hilversum, The Netherlands.
Strategies Trauma Limb Reconstr. 2022 Jan-Apr;17(1):1-6. doi: 10.5005/jp-journals-10080-1544.
Plate fixation is the treatment of choice for a midshaft clavicle non-union. Those non-unions that require >1 surgical procedure to heal are termed . Regardless of the number of previously failed procedures, our surgical strategy is aimed at achieving an optimal mechanical and biological environment to facilitate healing.
We performed a retrospective analysis of 14 patients with a recalcitrant clavicle non-union treated with open reduction and plate fixation combined with graft augmentation when indicated. Healing rates after index surgery were analysed. All patients were observed for at least 12 months.
All patients healed at a mean time of 193.2 days (range 90-390). Five of the 14 patients had at least one positive surprise culture, for which they received antibiotic treatment. At the latest follow-up, no patient reported pain or discomfort. Mean disability of the arm, shoulder and hand (DASH) score was 16.3 points (range 0-40), indicating only mild residual impairment. A possible link was found between the time between injury and definitive surgery and the time to healing [Pearson correlation 0.527, sig. (two-tailed) 0.000].
This study shows 100% bone healing and good functional outcomes after surgical revision for a recalcitrant clavicle non-union.
Grewal S, Baltes TPA, Wiegerinck E, Treatment of a Recalcitrant Non-union of the Clavicle. Strategies Trauma Limb Reconstr 2022;17(1):1-6.
钢板固定是治疗锁骨中段骨不连的首选方法。那些需要进行超过1次手术才能愈合的骨不连被称为 。无论之前失败手术的次数如何，我们的手术策略旨在营造一个最佳的力学和生物学环境以促进愈合。
我们对14例难治性锁骨骨不连患者进行了回顾性分析，这些患者在必要时接受切开复位、钢板固定并联合植骨增强治疗。分析了初次手术后的愈合率。所有患者均接受了至少12个月的观察。
所有患者均愈合，平均愈合时间为193.2天（范围90 - 390天）。14例患者中有5例至少有1次阳性伤口培养结果，为此他们接受了抗生素治疗。在最近一次随访时，没有患者报告疼痛或不适。手臂、肩部和手部功能障碍（DASH）评分的平均值为16.3分（范围0 - 40），表明仅存在轻度残余功能障碍。发现受伤至确定性手术的时间与愈合时间之间可能存在关联[Pearson相关性0.527，显著性（双侧）0.000]。
本研究表明，对难治性锁骨骨不连进行手术翻修后，骨愈合率达100%，功能结果良好。
Grewal S, Baltes TPA, Wiegerinck E, 治疗难治性锁骨骨不连。《创伤肢体重建策略》2022；17(1):1 - 6。
