Department of Orthopedic and Traumatology, Ankara City Hospital, Ankara, Turkey.
Department of Orthopedic and Traumatology, Çorlu State Hospital, Tekirdağ, Turkey.
Acta Chir Orthop Traumatol Cech. 2022;89(3):208-212.
PURPOSE OF THE STUDY Most humeral nonunions can be successfully treated with a single procedure, but some are more difficult to heal. Humeral nonunions which have two or more surgical procedures were defined as refractory humeral nonunions, and this condition is a very challenging condition. The aim of the study is to show the results of atrophic refractory humeral nonunion treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty. MATERIAL AND METHODS Refractory humeral nonunions treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty from January 2010 to March 2019 were included this study retrospectively. Patient baseline information, number of previous surgeries, comorbidities, follow-up time, fracture union time, and complications were recorded. The functional outcome was evaluated with the Constant scores and Mayo scores at the end of the first year. The primary outcome variable was mentioned as bony union. RESULTS A total of 13 refractory humeral nonunions included this study. The average age of the patients was 50.92±15.55 years (range, 26-78 years), and 8 of them were female. Preoperative and postoperative mean Mayo scores were; 56.54±17.84, and 85.38±7.49 respectively (p<0.001). Preoperative and postoperative mean Constant scores were; 45±11.71, and 80.62±5.38 respectively (p<0.001). DISCUSSION The strict application of basic nonunion principles can result in successful salvage of refractory humeral nonunions. But this concept may not provide sufficient solution for each situation. On the other hand, we also applied the basic nonunion principles. Compression plating and autogenous bone grafting and spongioplasty have been considered as the gold standard in the management of humeral shaft nonunion. CONCLUSIONS Open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty should be considered as an alternative for the treatment of refractory atrophic humeral nonunions, whose treatment is a very challenging condition for surgeons. Key words: block graft, bone grafting, nonunion, refractory humeral nonunion, spongioplasty.
研究目的
大多数肱骨骨不连可以通过单一手术成功治疗，但有些则更难愈合。有两次或更多次手术的肱骨骨不连被定义为难治性肱骨骨不连，这种情况是一种极具挑战性的情况。本研究的目的是展示采用切开复位内固定及自体髂骨骨块移植和骨海绵成形术治疗萎缩性难治性肱骨骨不连的结果。
材料与方法
本研究回顾性纳入 2010 年 1 月至 2019 年 3 月采用切开复位内固定及自体髂骨骨块移植和骨海绵成形术治疗的难治性肱骨骨不连患者。记录患者的基线资料、手术次数、合并症、随访时间、骨折愈合时间和并发症。术后第一年采用Constant 评分和 Mayo 评分评估功能结果。主要观察指标为骨性愈合。
结果
本研究共纳入 13 例难治性肱骨骨不连患者，平均年龄 50.92±15.55 岁（26-78 岁），女性 8 例。术前和术后平均 Mayo 评分分别为 56.54±17.84 和 85.38±7.49（p<0.001）；术前和术后平均 Constant 评分分别为 45±11.71 和 80.62±5.38（p<0.001）。
讨论
严格遵循骨不连的基本治疗原则可以成功治疗难治性肱骨骨不连，但这种方法可能并不适用于每种情况。另一方面，我们也遵循了骨不连的基本治疗原则。加压钢板内固定和自体骨移植及骨海绵成形术被认为是治疗肱骨干骨不连的金标准。
结论
切开复位内固定及自体髂骨骨块移植和骨海绵成形术可作为治疗难治性萎缩性肱骨骨不连的一种选择，这种情况的治疗对医生来说是极具挑战性的。
骨块移植；骨移植；骨不连；难治性肱骨骨不连；骨海绵成形术。
