Nikiforidis P, Babis G C, Vayanos E D
Clinique Orthopédique et Traumatologique de I'Université d'Athènes, Kifissia, Grèce.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(2):125-9.
The authors review and evaluate the operative treatment of mid-shaft clavicular non-union by compression plate osteosynthesis and most frequently by decortication and autogenous bone grafting.
From 1979 to 1990, 11 consecutive patients, 9 males and 2 females, mean age 33.5 years, with symptomatic non-union of mid-shaft clavicular fracture were operated and followed-up for an average of 4 years. The pseudarthrosis was atrophic in 10 and hypertrophic in 1 patient. The initial treatment of the fracture was always conservative.
All patients achieved bone union by 3-7 months post operatively. The functional results were excellent in 9 patients. The remaining two patients had mild symptoms such as occasional pain related to weather, soreness of the muscles with overhead lifting and discomfort of the shoulder. Minor complications were noted such as 1 delayed wound healing, 3 cheloid scars and 1 transient partial paresis of the brachial plexus.
Symptomatic non-union of the mid-shaft clavicular is a rare complication, mainly after non-operative treatment (11 cases in 12 years in our series). Factors responsible for non-union are the initial high velocity injury, the cominution, the overlapping and great displacement, the paucity of cancellous bone at this site and the trapezius interposition. Internal fixation by compression plating, decortication and bone grafting in atrophic non-union often encountered is a safe reliable method allowing uncomplicated healing and acceptable functional results.
作者回顾并评估采用加压钢板接骨术，以及最常用的去皮质术和自体骨移植术治疗锁骨中段骨不连的手术方法。
1979年至1990年，连续11例有症状的锁骨中段骨折骨不连患者接受手术治疗并随访，平均随访4年。其中男性9例，女性2例，平均年龄33.5岁。10例为萎缩性假关节，1例为肥大性假关节。骨折的初始治疗均为保守治疗。
所有患者术后3至7个月均实现骨愈合。9例患者功能结果优良。其余2例患者有轻微症状，如与天气有关的偶尔疼痛、举过头顶时肌肉酸痛和肩部不适。出现了一些轻微并发症，如1例伤口愈合延迟、3例瘢痕疙瘩和1例臂丛神经短暂性部分麻痹。
锁骨中段有症状的骨不连是一种罕见的并发症，主要发生在非手术治疗后（我们的系列研究中12年有11例）。导致骨不连的因素包括初始的高速损伤、粉碎、重叠和严重移位、该部位松质骨稀少以及斜方肌嵌入。对于常见的萎缩性骨不连，采用加压钢板内固定、去皮质术和骨移植是一种安全可靠的方法，可实现无并发症的愈合和可接受的功能结果。
