Peri-prosthetic humeral non-union: Where biology meets bio-mechanic. A case report.
Peri-prosthetic humeral non-union: Where biology meets bio-mechanic. A case report.
复制标题
统治性肱骨非工会：生物学符合生物力学的地方。案例报告。
DOI：
10.1016/j.ijscr.2017.08.001
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发表时间：
2017
影响因子：
0.6
通讯作者：
Doria C
中科院分区：
文献类型：
--
作者：
Emanuele C;Leonardo P;Gianfilippo C;Matteo A;Doria C
假体周围骨折不愈合是一个医学挑战，需要多层次的治疗。积极的翻修手术和骨愈合治疗是这些病例的最佳解决方案。机械稳定性和对成骨过程的支持可以导致骨折不愈合的病例。我们的方法遵循Giannoudis关于骨折愈合的“钻石概念”。近年来，由于人口的不断老龄化，世界范围内创伤性骨折的发病率一直在增长。如今，骨科手术中关节成形术的增加与假体周围骨折的高发生率有关。骨折愈合是一个多因素代谢过程；如果这些因素受损，愈合过程可能会中断，导致骨不连。我们报告一例肱骨骨干骨不连继发于假体周围骨折（反向肩关节置换术）的保守入路治疗的经验。我们采用多层方法治疗该患者，包括翻修手术和药物治疗。我们认为积极的自体骨修复手术和特立帕肽的骨愈合治疗可以减少骨不连的恢复期并改善预后。
Periprosthetic fracture non-unions are a medical challenge that requires a multi-level treatment. Aggressive revision surgery and bone healing therapy are the best solutions for those cases. The association of mechanical stability and the support to osteogenic processes can lead to fracture healing in non-union cases. Our method follows the Giannoudis’ “Diamond concept” about fracture healing. The worldwide incidence of traumatic fractures has been growing over the last years due to the progressive aging of the population. Today, the increase of arthroplasty procedures in orthopaedic surgery is related to a high rate of peri-prosthetic fractures. Healing of the fracture is a multifactorial metabolic process; if these factors are impaired, healing process could be interrupted resulting in non-union. We report our experience about a case of a humeral diaphysis non-union secondary to peri-prosthetic fracture (reverse shoulder arthroplasty) treated by conservative approach. We treated this patient using a multilevel approach, consisting of revision surgery and drug therapy. We assume that an aggressive revision surgery done with bone autograft implant and a bone healing therapy administering teriparatide off-label can reduce the convalescence in non-unions and can improve prognosis.