肱骨骨不连的原因分析及治疗

目的探讨肱骨骨不连的原因和不同固定、植骨方法治疗肱骨骨不连的临床疗效。方法对51例肱骨骨不连进行回顾性分析。固定方式：钢板内固定30例，交锁髓内钉内固定12例，单臂或组合式外固定架8例，异体骨板加螺钉内固定1例。植骨来源：自体髂骨植骨16例，重组合异种骨植骨(RBX)12例，自体髂骨联合RBX植骨17例，异体骨植骨2例，异体骨联合RBX植骨2例。结果51例患者中，2例失访。49例随访8个月～9年，平均4年7个月。总愈合率89．8％，钢板治疗组愈合率83．3％，外固定架治疗组愈合率100％，交锁髓内针治疗组愈合率100％。12例单独应用RBX植骨治疗肱骨骨不连全部愈合；自体髂骨联合RBX植骨15例愈合，愈合率88．2％；自体髂骨植骨14例愈合，愈合率87．5％。结论髓内针内固定或外固定架固定治疗肱骨骨不连较钢板优越，创伤小，固定确实，功能恢复满意；RBX植骨治疗骨不连，安全、无免疫排斥反应、生物相容性好，对促进骨愈合疗效可靠。

Causes and treatment of humerus bone nonunion

Objective To explore the causes of humerus bone nonunion and the c linic effects of different fixators and bone grafts in treatment of humerus bone nonunion. Methods 51 cases of humerus bone nonunion, 36 males and 15 females, w ere analyzed retrospectively. Different fixations were applied for the patients: plates in 30 cases, interlocking medullary nails in 12 cases, external fixators in 8 cases and allograft-bone plate with screws in 1 case. For bone graft, Rec onstructed Bone Xenograft (RBX) was used in 12 cases, autogenous ilium in 16 cas es, autogenous ilium plus RBX in 17 cases, allograft-bone in 2 cases and allogr aft-bone plus RBX in 2 cases. Results Of the 51 cases, 2 were out of follow-up , 49 cases were followed up for 8 months to 9 years, with 4 years and 7 months o n average. The total union-rate was 89.8%. The union-rate in patients with pl ate fixation was 83.3%, with external fixator 100%, and with interlocking medu llary nails 100%. The union-rate in patients with RBX was 100%, with autogeno us ilium 87.5%, and with autogenous plus RBX 88.2%. Conclusions The treatment of humerus bone nonunion with interlocking medullary nails or external fixators is superior to that with plates in that it is less invasive, and provides effect ive fixation and satisfactory functional recovery as well. Since RBX has good bi ocompatibility and does not result in immunological rejections, it can be safely used in the treatment of bone nonunion and has reliable effects on promoting bo ne healing.