肱骨骨不连的手术治疗

目的探讨肱骨骨不连的手术治疗方法及疗效。方法1998年12月～2005年5月共收治肱骨骨不连患者25例,均为肱骨骨折内固定术后发生骨不连,其中3例并发骨髓炎,6例合并不同程度肱骨骨缺损,骨缺损长度为3～6cm。骨不连病程8个月～5年。15例行吻合血管游离腓骨移植,10例采用加压交锁髓内针进行肱骨固定并辅以自体骨植骨。结果术后25例均得到随访,时间6个月～6年2个月。吻合血管游离腓骨移植组中移植的腓骨段均与肱骨干形成骨性愈合,平均骨性愈合时间为3．1个月；交锁髓内针组平均骨愈合时间为3．8个月。按Crates和Whittle肩肘关节功能评价标准,腓骨移植组：优9例,良4例,差2例；交锁髓内针组：优5例,良3例,差2例。结论应用加压交锁髓内针辅以自体骨移植对硬化性肱骨骨不连是一种有效的外科治疗方法；对合并骨髓炎、大段骨缺损及严重骨质疏松的肱骨骨不连,采用吻合血管游离腓骨移植可一期进行修复与重建。

Surgical treatment of complex humeral nonunion

Objective To discuss the effects and methods of the surgical treatment of complex humeral nonunion.Methods Ten cases of scleroid humeral nonunion were treated by compressive interlocking medullary nailing and autografting of iliac bone.Fifteen cases of humeral nonunion combined with osteomyelitis or osteoporosis were treated with grafting of free vascularized fibular flaps.Results All the cases were followed up for six months to six years.They all obtained bone union.The average time of bone union was 3.1 months for the free vascularized fibular grafting group and 3.8 months for the interlocking medullary nail group.Conclusions Compressive interlocking medullary nailing and autografting of iliac bone is effective for scleroid humeral nonunion,while grafting of free vascu- larized fibular flaps is effective for humeral nonunion combined with osteomyelitis or osteoporosis because the free vas- cularized fibular grafting can well reconstruct the defective humerus bone with osteoporosis or osteomyelitis.