van der Burg Fleur Ae, Baltes Thomas Pa, Kloen Peter
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, The Netherlands.
Shoulder Elbow. 2023 Feb;15(1):45-53. doi: 10.1177/17585732211064815. Epub 2021 Dec 17.
To evaluate the use of intercalary iliac crest bone graft in the treatment of clavicle nonunion with a large segmental bone defect (3-6 cm).
This retrospective study evaluated patients with large segmental bone defects (3-6 cm) after clavicle nonunion, treated with open reposition internal fixation and iliac crest bone graft between February 2003 and March 2021. At follow-up the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered. A literature search was performed to provide an overview of commonly used graft types per defect size.
We included five patients treated with open reposition internal fixation and iliac crest bone graft for clavicle nonunion with a median defect size of 3.3 cm (range 3-6 cm). Union was achieved in all five, and all pre-operative symptoms resolved. The median DASH score was 23 out of 100 (IQR 8-24). An extensive literature search revealed that there are no studies describing the use of an used iliac crest graft for defects larger than 3 cm. Instead, a vascularized graft was typically used to treat defects sizes between 2.5 and 8 cm.
An autologous non-vascularized iliac crest bone graft can be safely used and is reproducible to treat a midshaft clavicle non-union with a bone defect between 3 and 6 cm.
评估间置髂嵴骨移植在治疗伴有大段骨缺损（3 - 6厘米）的锁骨骨不连中的应用。
这项回顾性研究评估了2003年2月至2021年3月期间，因锁骨骨不连伴有大段骨缺损（3 - 6厘米）而接受切开复位内固定及髂嵴骨移植治疗的患者。随访时采用上肢、肩部和手部功能障碍（DASH）问卷进行评估。进行文献检索以概述每种缺损大小常用的移植类型。
我们纳入了5例因锁骨骨不连接受切开复位内固定及髂嵴骨移植治疗的患者，缺损大小中位数为3.3厘米（范围3 - 6厘米）。所有5例均实现了骨愈合，且所有术前症状均消失。DASH评分中位数为100分中的23分（四分位间距8 - 24）。广泛的文献检索显示，没有研究描述使用髂嵴移植治疗大于3厘米的缺损。相反，通常使用带血管蒂的移植来治疗2.5至8厘米大小的缺损。
自体非血管化髂嵴骨移植可安全用于治疗伴有3至6厘米骨缺损的锁骨中段骨不连，且结果具有可重复性。
