摘要
目的探讨交胸肋骨瓣结合双钢板固定治疗肱骨下段骨不连的方法和疗效。方法2000年2月-2006年5月收治肱骨下段骨不连21例。男13例,女8例;年龄17～56岁,平均36.5岁。根据AO分型:A1.3型5例,B1.3型7例,B2.3型6例,B3.3型2例,C1.3型1例。所有骨不连均为内固定术后发生,骨折端骨质吸收12例,钢板断裂3例,内固定松动6例;其中肥大型8例,萎缩型13例。均无假关节形成。发生骨不连时间8个月～3年,平均1.5年。所有患者均采用第7～9肋带血管蒂交胸肋骨瓣(长3.0～3.5cm)结合双钢板固定治疗,术后8～10周断蒂,积极进行功能锻炼。结果术后供、受区切口均Ⅰ期愈合。21例均获随访,随访时间1～3年,平均18.2个月。X线片示所有患者移植肋骨瓣均于术后3～5个月,平均3.5个月与肱骨干形成骨性愈合,未发现医源性桡神经损伤。肘关节功能参照美国特种外科医院评分(HSS)标准,为81.7～92.5分,平均89.3分;获优14例,良4例,差3例,优良率85.7%。结论交胸肋骨瓣植入结合双钢板固定是一种治疗肱骨下段骨不连的有效方法。
Objective To evaluate the result of treating nonunion of lower segment of humerus with combination of rib flaps of cross chest and double plates.Methods From Feburary 2000 to May 2006,21 cases of nounion of lower segment of humerus were treated.There were 13 males and 8 females with an average age of 36.5 years（range,17-56 years）.According to AO classification,there were 5 cases of type A1.3,7 cases of type B1.3,6 cases of type B2.3,2 cases of type B3.3,and 1 case of type C1.3.All nonunion occurred after internal fixation,which was caused by bone resorption at fracture end in 12 cases,by plates breakage in 3 cases,and by internal fixation loosening in 6 cases;including 8 cases of hypertrophic nonunion and 13 cases of atrophy nonunion without pseudoarthrosis.An average time of nonunion was 1.5 years（from 8 months to 3 years）.All cases were treated with combination of rib flaps of cross chest（length,3.0-3.5 cm）and double plates.The pedicle was divided 8 to 10 weeks after operation and all cases carried out functional exercise.Results The patients were followed up for an average time of 18.2 months（range,1-3 years）.All nounion of lower segment of humerus were healed and no radial nerve injury occurred. Primary healing of wound was achieved at both donor and recipient sites.Bony union was achieved in all cases after an average time of 3.5 months（range,3-5 months）after operation.According to the the Hospital for Special Surgery（HSS）functional elbow index,the average score was 89.3（range,81.7-92.5）and the outcome was excellent in 14 cases,good in 4 cases,and poor in 3 cases,the excellent and good rate was 85.7%.Conclusion Combination of rib flaps of cross chest and double plates is an effective method of treating nonunion of lower segment of humerus.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期74-77,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肱骨下段骨折
骨不连
带蒂肋骨瓣
双钢板
Lower segment of humerus fracture Nonunion Pedicled rib flaps Double plates
