Sun Zhijian, Liu Gang, Kanakaris Nikolaos K, Li Ting, Wu Xinbao, Giannoudis Peter V
Department of Orthopaedics Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 10035, China.
Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK.
Eur J Trauma Emerg Surg. 2025 Jun 11;51(1):225. doi: 10.1007/s00068-025-02904-9.
Acute shortening of the upper extremity could be used in patients with segmental bone loss or large soft tissue defects. The study aimed to review available evidence about acute shortening procedures of the upper extremities to evaluate the common indications and tolerable shortening length.
All clinical studies involving acute shortening procedures of the upper extremity were considered eligible for inclusion. PubMed, Embase, Web of Science and Cochrane Library for English-language articles from inception to December 2024 were searched. Two reviewers independently charted data from each eligible article.
Out of 730 studies screened, 35 articles met the inclusion criteria. There were 24 case series and 11 case reports containing 355 acute shortening procedures. Acute shortening was reported in 12 articles for amputation, 15 for fracture nonunion, 2 for fresh or delayed fracture, 2 for tumor, 2 for brachial plexus injury and 2 for forearm deformity. The maximum shortening for replantation was 10 cm in the forearm and 12 cm in the humerus. Shortening up to 2.9 cm and 8 cm for fracture nonunion were reported for the forearm and humerus, respectively.
The main indications for acute shortening of the upper limb were amputation for replantation and fracture nonunion. Aggressive bony shortening was recommended in the setting of amputations. Controversies existed about the tolerated shortening length for both the forearm and humerus.
急性上肢缩短术可用于节段性骨缺损或大面积软组织缺损患者。本研究旨在回顾有关上肢急性缩短术的现有证据，以评估常见适应证和可耐受的缩短长度。
所有涉及上肢急性缩短术的临床研究均被认为符合纳入标准。检索了PubMed、Embase、Web of Science和Cochrane图书馆中从创刊到2024年12月的英文文章。两名研究者独立提取每篇符合条件文章的数据。
在筛选的730项研究中，35篇文章符合纳入标准。有24个病例系列和11个病例报告，共包含355例急性缩短术。12篇文章报道了用于断肢再植的急性缩短术；15篇用于骨折不愈合；2篇用于新鲜或延迟骨折；2篇用于肿瘤；2篇用于臂丛神经损伤；2篇用于前臂畸形。前臂断肢再植的最大缩短长度为10厘米，肱骨为12厘米。前臂和肱骨骨折不愈合的缩短长度分别报道可达2.9厘米和8厘米。
上肢急性缩短术的主要适应证是断肢再植和骨折不愈合。在断肢情况下建议进行积极的骨缩短。前臂和肱骨的可耐受缩短长度存在争议。
