Mukhopadhaya John, Bhadani Janki Sharan, Ranjan Rajeev, Kushwaha Shubhanshu Ranjan
Department of Orthopaedics, PARAS HMRI Hospital, Patna, Bihar 800014 India.
Indian J Orthop. 2024 Dec 5;58(12):1793-1805. doi: 10.1007/s43465-024-01290-5. eCollection 2024 Dec.
Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3-5% of all fractures, have nonunion rates of 2-33% in nonoperative and 5-10% in surgical management. This study, the largest case series on operative management of humeral shaft nonunion, examines surgical techniques and outcomes. This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from 2002 to 2020. Cases were from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20-70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathological fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using DASH, VAS, and constant shoulder score scores at a minimum follow-up of 24 months. The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Union was achieved in 21 weeks on average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful complication management to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and one case of transient radial nerve palsy. Absolute stability using a plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiological and functional outcome.
无菌性骨不连在骨科临床中较为常见，会导致持续疼痛和功能障碍。肱骨干骨折占所有骨折的3% - 5%，非手术治疗的骨不连发生率为2% - 33%，手术治疗的发生率为5% - 10%。本研究是关于肱骨干骨不连手术治疗的最大病例系列，探讨了手术技术及疗效。这项回顾性研究在印度东部的一家转诊中心进行，纳入了2002年至2020年期间132例无菌性肱骨干骨不连患者。病例来自2002年5月至2012年4月以及2015年5月至2020年12月。纳入年龄在20 - 70岁、创伤后骨不连超过6个月的患者。排除开放性骨折、感染、间隙性骨不连、病理性骨折以及合并的上肢损伤。手术技术包括切除纤维组织和不健康组织、压缩骨不连部位、去皮质、叠瓦状植骨、自体骨移植以及使用动力加压钢板或锁定加压钢板进行稳定固定。在至少24个月的随访期内，使用上肢功能障碍评分（DASH）、视觉模拟评分（VAS）和肩关节Constant评分对疗效进行评估。该研究纳入132例患者，其中男性84例，女性48例，平均年龄42.3岁。78例骨折由高能创伤导致，54例由低能创伤导致。所有患者均接受了自体骨移植和钢板固定技术。上肢功能障碍快速评分（Quick DASH）平均从77分改善至5分。平均21周实现骨愈合，并发症极少。尽管时间间隔、治疗方法和随访时长存在差异，但一致的治疗策略强调稳定固定、骨移植以及仔细的并发症管理，以实现高骨愈合率和满意的疗效。并发症包括7例感染、1例固定失败需要再次固定以及1例短暂性桡神经麻痹。对于无菌性肱骨干骨不连，使用带或不带自体骨移植的钢板实现绝对稳定可带来高骨愈合率以及满意的影像学和功能疗效。
