带锁髓内钉与钢板内固定治疗成人肱骨干骨折疗效的对比分析

目的:对比分析带锁髓内钉与钢板内固定治疗成人肱骨干骨折的临床疗效,评价两种手术治疗方案的优劣。方法:选取2002年6月至2007年5月我院收治的成年人肱骨干骨折患者69例,其中应用带锁髓内钉治疗31例,钢板内固定治疗38例。临床及影像学评价骨折愈合时间、术后桡神经损伤、感染、术后患肢肿胀情况及术后肩关节功能(Neer评分)。结果:所有患者均获得随访,随访时间6~38个月,平均18个月。平均临床愈合时间髓内钉组11.8周,钢板组12.9周;平均放射学骨折线消失时间髓内钉组9.4周,钢板组10.8周;术后两组均未发生骨感染;术后肩关节功能评分,髓内钉组优29例,良2例,钢板组优38例。以上结果两组之间均无显著性差异。髓内钉组术后患肢肿胀时间(11周)超过钢板组(4周),初次术后及取内固定术中钢板组均有发生桡神经麻痹者(5例),髓内钉组则无;髓内钉组未发生骨不连,钢板内固定组有1例出现骨不连接。结论:髓内钉及钢板内固定对于治疗肱骨干骨折均能提供稳定的内固定并愈合,但髓内钉内固定对于减少手术并发症更具优势。

Comparison Study of Intramedullary Nails and Plates Internal Fixation for the Treatment of humeral shaft fractures in adult

Objective To comparatively analyze the clinical effects of interlocking intramedullary nail and plates internal fixation in treating of humeral shaft fractures and evaluate the merits and defects of the two methods.Methods From June 2002 to May 2007,69 patients with humeral shaft fractures were choosed at random.31 cases were treated with interlocking intramedullary nail and 38 cases were treated with plates internal fixation.The data in each group were collected for statistical analysis on the following aspects: the operative duration,the intraoperative blood loss,the time of initiation of exercise after operation,complications,the excellent and good rate and the function evaluation of affected hip joint.Clinical outcome measurements included fracture healing,radial nerve injury,infection,shoulder function according to Neer's score and soft tissue engorgement.Results All the cases were followed up,the average followed-up time was 18 months ranged from 6 months to 38.The average time of healing were 11.8 weeks in interlocking intramedullary nail group and 12.9 weeks in plates internal fixation group.100% of patients had good to excellent postoperative shoulder function,4 cases displayed postoperative radial never palsy in plates group,but no case has iatrogenic injury in intramedullary nail group.Four cases with swollen limbs persisted over 2 weeks in plates group while 11 cases with swollen limbs persisted over 2 weeks in intramedullary nail group.Nonunion occurred on 1 cases in plate group.Conclusion For patients who need surgical treatment of a humeral shaft fracture,both interlocking intramedullary nailing and compression plating provide predictable results for achieving fracture stabilization and ultimate healing,but IIN has fewer complications.