Mühlenfeld Nils, Wagner Ferdinand C, Hupperich Andreas, Heykendorf Lukas, Frodl Andreas, Obid Peter, Kühle Jan, Schmal Hagen, Erdle Benjamin, Jaeger Martin
Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany.
Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000 Odense, Denmark.
J Clin Med. 2024 Aug 16;13(16):4850. doi: 10.3390/jcm13164850.
The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0-196). Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% ( = 19), while no bone addition was used in 62.0% ( = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% ( = 17) in patients for whom additional bone grafting was used and 96.2% ( = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups ( = 0.2425). Differences between groups in the rate of consolidation were not significant ( = 0.7890). The complication rate was low, with 4.5% ( = 2). Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases.
传统上，骨不连的手术治疗在萎缩性骨不连时采用额外的骨移植，在肥大性骨不连时采用更强的植入物。然而，就锁骨骨干而言，根据我们的经验，一种更具争议性的方法（即无需额外骨移植）能带来同样良好的骨愈合率，且与骨不连形态无关。该方法需要根据AO相对稳定性原则对初始骨折进行细致的解剖重建和固定。我们按照STROBE指南对2003年1月至2023年12月期间在弗莱堡大学医学中心接受锁骨中段骨不连手术治疗的所有连续队列患者进行了回顾性研究。通过医院信息系统（HIS）中的回顾性系统查询，使用德国诊断相关组（G-DRG）的国际疾病和相关健康问题统计分类第10版（ICD-10）编码来识别患者。将接受取自髂嵴的额外骨移植的患者与未接受骨移植的患者分为两组，比较其骨愈合率。所有患者均使用3.5毫米重建锁定加压钢板（LCP）。通过随访X光片评估骨愈合率，并在取出内固定物后评估结果，平均随访时间为31.5±44.3个月（范围0 - 196个月）。最终数据包括50例患者，以男性为主（29例:21例）；年龄：46.0±13.0岁，体重指数（BMI）26.1±3.7。38.0%（n = 19）的患者使用了取自髂嵴的自体骨移植，62.0%（n = 30）的患者未使用额外骨移植。6例患者失访。其余44例患者平均在15.1±8.0个月后记录到影像学骨愈合。使用额外骨移植的患者骨愈合率为94.4%（n = 17），未使用骨移植的患者骨愈合率为96.2%（n = 25）。两组间萎缩性或肥大性骨不连的比例无显著差异（p = 0.2425）。两组间骨愈合率的差异不显著（p = 0.7890）。并发症发生率较低，为4.5%（n = 2）。无论骨不连形态如何，大多数情况下，锁骨中段骨不连可通过3.5毫米锁定重建钢板成功治疗，无需使用额外骨移植。
