中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
5期
378-382
,共5页
张云辉%贺韬%张超%董宇启
張雲輝%賀韜%張超%董宇啟
장운휘%하도%장초%동우계
解剖锁定接骨板%改良加垫式植骨%骨不连
解剖鎖定接骨闆%改良加墊式植骨%骨不連
해부쇄정접골판%개량가점식식골%골불련
anatomic locking plate%modified padded bone graft%bone nonunion
背景：近年来，锁骨骨折接受手术治疗患者越来越多，因内固定失效致骨不连患者也渐多。国内外报道多针对锁骨骨不连的治疗方法，但在植骨方式的选择上尚存争议。<br> 目的：探讨解剖锁定接骨板结合自体骨改良加垫式植骨治疗锁骨骨不连的临床效果。<br> 方法：2006年3月至2014年8月采用切开复位解剖锁定接骨板内固定结合自体骨髂骨加垫式植骨术治疗9例锁骨中段骨不连，记录手术时间，术后随访行X线片检查观察骨折愈合情况，并采用简短肩臂手残障功能评分系统（quick-DASH）评估其功能情况，末次随访胸部正位X线片，通过对比患侧与健侧的锁骨长度评价锁骨骨不连愈合后的短缩情况。<br> 结果：9例患者的平均手术时间为（112.22±19.22）min；均获得骨性愈合，无感染、接骨板断裂及再骨折发生，平均愈合时间为（10.67±2.83）周；术后quick-DASH为（14.33±1.66）分；末次随访患侧锁骨长度较健侧平均短缩（0.27±0.09）cm，两侧锁骨长度对比无显著性差异（P＞0.05）。<br> 结论：解剖锁定接骨板结合自体骨改良加垫式植骨是治疗锁骨骨不连的一种有效方法，能有效防止锁骨短缩，恢复患肢的良好功能。
揹景：近年來，鎖骨骨摺接受手術治療患者越來越多，因內固定失效緻骨不連患者也漸多。國內外報道多針對鎖骨骨不連的治療方法，但在植骨方式的選擇上尚存爭議。<br> 目的：探討解剖鎖定接骨闆結閤自體骨改良加墊式植骨治療鎖骨骨不連的臨床效果。<br> 方法：2006年3月至2014年8月採用切開複位解剖鎖定接骨闆內固定結閤自體骨髂骨加墊式植骨術治療9例鎖骨中段骨不連，記錄手術時間，術後隨訪行X線片檢查觀察骨摺愈閤情況，併採用簡短肩臂手殘障功能評分繫統（quick-DASH）評估其功能情況，末次隨訪胸部正位X線片，通過對比患側與健側的鎖骨長度評價鎖骨骨不連愈閤後的短縮情況。<br> 結果：9例患者的平均手術時間為（112.22±19.22）min；均穫得骨性愈閤，無感染、接骨闆斷裂及再骨摺髮生，平均愈閤時間為（10.67±2.83）週；術後quick-DASH為（14.33±1.66）分；末次隨訪患側鎖骨長度較健側平均短縮（0.27±0.09）cm，兩側鎖骨長度對比無顯著性差異（P＞0.05）。<br> 結論：解剖鎖定接骨闆結閤自體骨改良加墊式植骨是治療鎖骨骨不連的一種有效方法，能有效防止鎖骨短縮，恢複患肢的良好功能。
배경：근년래，쇄골골절접수수술치료환자월래월다，인내고정실효치골불련환자야점다。국내외보도다침대쇄골골불련적치료방법，단재식골방식적선택상상존쟁의。<br> 목적：탐토해부쇄정접골판결합자체골개량가점식식골치료쇄골골불련적림상효과。<br> 방법：2006년3월지2014년8월채용절개복위해부쇄정접골판내고정결합자체골가골가점식식골술치료9례쇄골중단골불련，기록수술시간，술후수방행X선편검사관찰골절유합정황，병채용간단견비수잔장공능평분계통（quick-DASH）평고기공능정황，말차수방흉부정위X선편，통과대비환측여건측적쇄골장도평개쇄골골불련유합후적단축정황。<br> 결과：9례환자적평균수술시간위（112.22±19.22）min；균획득골성유합，무감염、접골판단렬급재골절발생，평균유합시간위（10.67±2.83）주；술후quick-DASH위（14.33±1.66）분；말차수방환측쇄골장도교건측평균단축（0.27±0.09）cm，량측쇄골장도대비무현저성차이（P＞0.05）。<br> 결론：해부쇄정접골판결합자체골개량가점식식골시치료쇄골골불련적일충유효방법，능유효방지쇄골단축，회복환지적량호공능。
Background:There is a growing trend to treat clavicular fractures with open reduction and plate fixation, so nonunion has become common because of fixation failure. Surgical methods for clavicular nonunion have been reported, however, the se-lection of bone graft is still in dispute. <br> Objective:To investigate clinical outcomes of anatomic locking plate with modified padded bone graft in the treatment of nonunion of mid-shaft clavicle fractures. <br> Methods:From March 2006 to August 2014, 9 cases of nonunion of mid-shaft clavicle fracture were treated with open re-duction and internal fixation by anatomic locking plate with modified padded bone graft. Operation time and union time were recorded. The union of fracture was measured by radiographic examination. Functional outcomes were evaluated ac-cording to the quick disability of arm, shoulder and hand score (quick-DASH). The length of affected clavicle was com-pared with the healthy one at the last follow-up. <br> Results: The average operation time was (112.22 ± 19.22) min. Bone union was achieved in all patients, and the average union time was (10.67±2.83) weeks. No infection, pain, refracture or breakage of plate occurred. The average quick-DASH scores were 14.33±1.66. Compared with the healthy side, the affected clavicle shortened by (0.27±0.09) cm (P>0.05). <br> Conclusions:Anatomic locking plate with modified padded bone graft is an effective method for nonunion of mid-shaft clav-icle fractures, which can prevent the shortening of the clavicle and recover the function of the clavicle.
