Nonunions of the Humeral Shaft

肱骨骨折之不癒合

薛繼申(Chee-Sian Shih) ； 蘇榮源(Rong-Yuan Su) ； 黃德揚(Der-Young Hwang) ； 李龍駒(Long-Gyu Li) ； 黃俊雄(Chun-Hsiung Huang)

《Journal of Orthopaedic Surgery Taiwan》 10卷4期 (1993/12) Pp. 439-447

摘要

肱骨骨折佔全身骨折約1%，其骨折治療方法是以保守療法為主。據報告，肱骨骨折後面發生之不癒合率約0-15%，而治療不癒合性骨折則是以手術為主，目前以鋼板固定骨折加上自體股移植為治療公股不癒合之最佳方法。馬偕醫院從1980年11月至1992年12月，共收集59例肱骨骨折不癒合，我們發現橫斷面骨折，短斜性骨折，粉碎性骨折，中1/3處骨折及不穩定之開放骨折固定均與肱骨骨折不癒合有關，此59例中有53例接受開放性鋼板骨折固定及自體移植，3例接受骨髓內釘及自體股移植，另有2例因曾接受鋼板固定手術，故只接受自體股移植，最後一例只接受鎖定式骨髓內釘固定之。在追蹤過程中，我們以患者臨床上的症狀及X光上的骨折瘉合來判定是否智育。經過平均28個月的追蹤檢查，在53例以鋼板及自體股移植並患有50例癒合，2例以骨髓內釘及體股移植癒合，只接受自體股移植的2名患者也治癒，而接受鎖定是骨髓內釘固定之病例則失敗。總治癒率約91.5%(54/59)。
在治療的過程中，我們發現穩定性骨折固定為治療肱骨骨折不癒合中的重要步驟之一，以鋼板固定時，在骨折綫上至少6個骨面固定，則可達到此程度的骨折固定。另外，骨折間的不癒合纖維組織切除，骨折面的鑽洞，及自體骨移植均是治療肱骨不癒合骨折的重要步驟。

並列摘要

Fifty-nine patients with nonunion of the humeral shaft were reviewed between Nov. 1980 and Dec 1992, There were 50 atrphic nonunions and 9 hypertrophic nonunions. A total of 64 surgical procedures were performed on 59 patients, an average of 1.1 operations per nonunion. Fifty-three cases were treated with dynamic compression plates and bone grafts, 3with Kuntscher nail and bone graft, 2 with bone graft alone and 1 with interlocking nail alone.
Of those treated with dynamic compression plates and bone grafts, 50 were found to be united with 94.3%(50/53)healing rate. Two of three cases treated with Kuntscher nails and bone grafts healed, Both patients treated with bone graft only healed successfully, the overall healing rate was 91.5 %(54/59).
It is concluded that the treatment of the humeral shaft nonunion consists of decortication, proper plating and autologous cancellous bone graft.

並列關鍵字

Ununited ； Humeral Fractures ； Bone plates