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[1]曹進(jìn),胡珊珊,鄭華江,等.閉合復(fù)位彈性髓內(nèi)釘內(nèi)固定與切開復(fù)位鎖定加壓鋼板 內(nèi)固定治療青少年肱骨干骨折的療效比較[J].中醫(yī)正骨,2015,27(01):9-12.
　CAO Jin,HU Shanshan,ZHENG Huajiang,et al.A clinical comparison of closed reduction and elastic stable intramedullary nail internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):9-12.
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閉合復(fù)位彈性髓內(nèi)釘內(nèi)固定與切開復(fù)位鎖定加壓鋼板 內(nèi)固定治療青少年肱骨干骨折的療效比較()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年01期
頁碼:
9-12
欄目:
臨床研究
出版日期:
2015-01-15

文章信息/Info

Title:
A clinical comparison of closed reduction and elastic stable intramedullary nail internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents
作者:
曹進(jìn); 胡珊珊; 鄭華江; 姚陸豐; 仲肇平
浙江省寧波市第六醫(yī)院,浙江 寧波 315040
Author(s):
CAO Jin; HU Shanshan; ZHENG Huajiang; YAO Lufeng; ZHONG Zhaoping
The 6th hospital of Ningbo city,Ningbo 315040,Zhejiang,China
關(guān)鍵詞:
肱骨骨折;  骨折固定術(shù); 內(nèi);  青少年
Keywords:
humeral fractures;  fracture fixation; internal;  adolescent
摘要:
目的:比較閉合復(fù)位彈性髓內(nèi)釘內(nèi)固定與切開復(fù)位鎖定加壓鋼板內(nèi)固定治療青少年肱骨干骨折的臨床療效和安全性。方法:回顧性分析采用閉合復(fù)位彈性髓內(nèi)釘內(nèi)固定和切開復(fù)位鎖定加壓鋼板內(nèi)固定治療的57例青少年肱骨干骨折患者的病例資料,男36例,女21例; 年齡14～18歲,中位數(shù)16歲。均為閉合性損傷。受傷至手術(shù)時間2～5 d,中位數(shù)3 d。閉合復(fù)位彈性髓內(nèi)釘內(nèi)固定28例,切開復(fù)位鎖定加壓鋼板內(nèi)固定29例。記錄2組患者手術(shù)時間、術(shù)中出血量、住院時間,隨訪觀察術(shù)后骨折愈合、患肢功能恢復(fù)及并發(fā)癥發(fā)生情況,并進(jìn)行比較。結(jié)果:57例患者均順利完成手術(shù),彈性髓內(nèi)釘組手術(shù)時間較鎖定加壓鋼板組短,且術(shù)中出血量少[(32.1±5.6)min,(103.8±25.2)min,t=30.770,P=0.000;(13.9±3.9)mL,(171.0±58.2)mL,t=14.246,P=0.000]; 但2組患者住院時間比較,組間差異無統(tǒng)計(jì)學(xué)意義[(8.8±1.10)d,(9.1±1.3)d,t=1.006,P=0.319]。57例患者均獲隨訪,隨訪時間12～36個月,中位數(shù)25個月; 骨折均愈合,彈性髓內(nèi)釘組骨折愈合時間較鎖定加壓鋼板組長[(10.7±2.2)周,(9.3±1.9)周; t=2.440,P=0.018]。采用Constant評分標(biāo)準(zhǔn)評價肩關(guān)節(jié)功能,彈性髓內(nèi)釘組優(yōu)26例、良1例、可1例,鎖定加壓鋼板組優(yōu)26例、良2例、可1例,2組間差異無統(tǒng)計(jì)學(xué)意義(Z=-0.407,P=0.684)。采用Mayo肘關(guān)節(jié)功能評分標(biāo)準(zhǔn)評價肘關(guān)節(jié)功能,彈性髓內(nèi)釘組優(yōu)25例、良2例、可1例,鎖定加壓鋼板組優(yōu)25例、良2例、可2例,2組間差異無統(tǒng)計(jì)學(xué)意義(Z=-0.378,P=0.705)。2組患者均無感染、內(nèi)固定斷裂、骨折畸形愈合等并發(fā)癥發(fā)生。彈性髓內(nèi)釘組并發(fā)骨折延遲愈合1例,未行特殊處理,術(shù)后16周骨折愈合。鎖定加壓鋼板組術(shù)后并發(fā)橈神經(jīng)損傷4例,經(jīng)積極功能鍛煉后,患肢功能恢復(fù); 拆除內(nèi)固定后并發(fā)再骨折1例,再次行切開復(fù)位鎖定加壓鋼板固定后骨折愈合。2組患者并發(fā)癥發(fā)生率比較,組間差異無統(tǒng)計(jì)學(xué)意義(χ2=0.802,P=0.371)。結(jié)論:采用閉合復(fù)位彈性髓內(nèi)釘內(nèi)固定和切開復(fù)位鎖定加壓鋼板內(nèi)固定治療青少年肱骨干骨折,均有利于患肢功能的恢復(fù),療效相當(dāng),安全可靠; 前者較后者手術(shù)時間短、損傷小,但骨折愈合時間長。
Abstract:
Objective:To compare the clinical curative effect and safety of closed reduction and elastic stable intramedullary nail(ESIN)internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents.Methods:The medical records of 57 adolescent patients with closed fracture of humeral shaft were analyzed retrospectively.The patients consisted of 36 males and 21 females,ranged in age from 14 to 18 years(Median=16 yrs),and ranged in disease course from 2 to 5 days(Median=3 days).Closed reduction and ESIN internal fixation were performed in 28 patients(ESIN group)and open reduction and locking compression plate internal fixation were performed in 29 patients(locking compression plate group).Then the operative time,blood loss,hospital stay,fracture healing,limbs functional recovery and complications were recorded and compared between the 2 groups.Results:The surgery were performed successfully on 57 patients.ESIN group has shorter operation time and less intraoperative blood loss compared to locking compression plate group(32.1+/-5.6 vs 103.8+/-25.2 min,t=30.770,P=0.000; 13.9+/-3.9 vs 171.0+/-58.2 ml,t=14.246,P=0.000),while there was no statistical difference in the hospital stay between the 2 groups(8.8+/-1.10 vs 9.1+/-1.3 days,t=1.006,P=0.319).The patients in the 2 groups were all followed up for 12-36 months with a median of 25 months.All fractures united and fracture healing time was longer in ESIN group compared to locking compression plate group(10.7+/-2.2 vs 9.3+/-1.9 weeks; t=2.440,P=0.018).According to Constant shoulder performance score,26 patients obtained an excellent result,1 good and 1 fair in the ESIN group; while 26 patients obtained an excellent result,2 good and 1 fair in the locking compression plate group; there was no statistical difference between the 2 groups(Z=-0.407,P=0.684).According to Mayo elbow performance score,25 patients obtained an excellent result,2 good and 1 fair in the ESIN group; while 25 patients obtained an excellent result,2 good and 2 fair in the locking compression plate group; there was no statistical difference between the 2 groups(Z=-0.378,P=0.705).No complications such as infection,breakage of internal fixators and fracture malunion were found in the 2 groups.One case of fracture delayed-union was found in ESIN group and the fracture united at 16th week after the surgery without special treatment.Four cases of postoperative radial nerve injury were found in locking compression plate group,and the function of affected limb recovered after active functional exercises.One case of refracture was found after removing internal fixator,and the fracture united after open reduction and locking compression plate internal fixation.There was no statistical difference in complication rates between the 2 groups(chi(2)=0.802,P=0.371).Conclusion:For treatment of humeral shaft fracture in adolescents,closed reduction internal fixation with ESIN and open reduction internal fixation with locking compression plate are similar to each other in limb function recovery,clinical curative effect and safety; however,the former has short operation time,less injury and long fracture healing time.

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備注/Memo

備注/Memo:
2014-07-22收稿 2014-09-11修回
更新日期/Last Update: 2015-01-30