髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连

目的 探讨髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连的疗效。方法 1999年6月至2008年5月共收治27例肱骨干骨不连患者，男14例，女13例；年龄24～65岁，平均35.5岁；左侧11例，右侧16例；骨不连部位：中上段6例，中段16例，中下段5例。骨不连类型：肥大型22例，萎缩型5例。所有患者均1～4次手术史，平均2.3次。16例采用肱骨交锁髓内钉固定，其中1例闭合穿髓内钉，5例采用更换原髓内钉后外加钢缆张力带固定；11例采用肱骨膨胀髓内钉。除1例闭合复立固定的患者外，其余26例患者均行自体髂骨植骨。结果 26例患者术后获1年3个月至8年6个月（平均4年2个月）随访，骨不连均获骨性愈合，愈合时间为4～8个月（平均5.4个月）。肩关节功能按Neer评分标准评定：优12例，良8例，可6例，优良率为76.9％。肘关节功能按Mayo评分标准评定：优23例，良3例，优良率为100％。1例桡神经损伤患者术后6个月恢复伸腕、伸拇及伸指功能。结论 肱骨髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连具有骨愈合率高、对肩肘关节影响小等优点。

Humeral diaphyseal nonunions treated by interlocking or expandable intrameduilary nailing plus iliac bone grafting

Objective To discuss the efficacy of interlocking or expandable intramedullary nailing plus iliac bone grafting for treatment of humeral diaphyseal nonunion.Methods From June 1999 to May 2008, 27 cases of humeral diaphyseal nonunion, 14 males and 13 females, were treated in our department.The nonunions occurred at the upper-middle humerus in 6 cases, at the middle humerus in 16 cases and at the middle-lower humerus in 5 Cases. The patients had previously undergone operations for 1 to 4 times (average,2.3 times). Interlocking nailing was applied in 16 cases (including one case of close nailing and 5 cases of cable tension band osteosynthesis after replacement of the original nailing); expandable nailing was applied in 11 cases. Autologous iliac bone grafting was performed in 26 cases except the one case of close nailing.Results Twenty-six cases were followed up for an average of 4 years and 2 months. Bony healing was obtained in 5.4 months on average. By Neer scoring, the shoulder functions were evaluated as excellent in 12,good in 8 and fair in 6 cases, with a good to excellent rate of 76. 9％. By Mayo clinic performance scoring,the elbow functions were excellent in 23 and good in 3 cases, with a good to excellent rate of 100％. One case of radial nerve palsy recovered 6 months after operation.ConclusionInterlocking or expandable intramedullary nailing plus iliac bone grafting is an effective method to treat nonunion of humeral diaphysis.