3种手术方法治疗肱骨干骨折疗效比较

目的 比较单一加压钢板螺钉＋髓内针固定、交锁髓内钉固定及微创有限内固定＋外支架固定治疗肱骨干骨折的疗效。方法 66例肱骨干骨折患者依据治疗方法分为3组,钢板组（24例）行单一加压钢板螺钉＋髓内针固定治疗,髓内钉组（22例）行交锁髓内钉固定治疗,外固定架组（20例）行微创有限内固定＋外支架固定治疗,比较3组术后骨折愈合时间、肩关节功能评分、肘关节功能评分及手术并发症发生情况。结果 外固定架组骨折愈合时间（（8.55±3.09）个月）较钢板组（（5.67±4.60）个月）及髓内钉组（（5.09±2.49）个月）长（P〈0.05）,钢板组与髓内钉组比较差异无统计学意义（P〉0.05）;钢板组、髓内钉组和外固定架组肩关节功能评分分别为31.08±5.12、29.91±3.74、28.95±4.12,3组间比较差异均无统计学意义（P〉0.05）;钢板组肘关节功能评分（83.00±14.40）高于外固定架组（73.35±16.40）（P〈0.05）;外支架组术后无骨折不愈合发生,钢板组发生骨折延迟愈合2例、螺钉松动5例,髓内钉组骨折断端有假关节形成3例、骨折不愈合并感染2例,钢板组、髓内钉组和固定架组并发症发生率分别为29.17%、22.73%、0,3组比较差异有统计学意义（P〈0.05）。结论 单一加压钢板螺钉＋髓内针固定可作为肱骨干骨折的首选手术方法,微创有限内固定＋外支架固定适用于严重粉碎性、开放性及伴有严重感染的骨折类型。

Comparison of three different devices for humeral shaft fracture

Objective To compare the effects of single compressed plate plus intramedullary pin, interlocking intramedullary nail, and simple arm external fixator plus simple internal fixation device for humeral shaft fracture. Methods Sixty-six cases of humeral fractures were divided into 3 groups according to different treatment methods, plate group （n=24） were treated with single compression plate plus intramedullary nail, intramedullary nail group （n= 22） were fixed with interlocking intramedullary nail, and external fixation group （n= 20） were treated with minimally invasive technique by limited internal fixation plus external fixator. The fracture healing time, score of shoulder joint function, score of elbow joint function and operation complications were observed and compared among three groups. Results The healing time was longer in external fixation group （（8. 55±3. 09） months） than that in plate group （（5. 67 ± 4. 60） months） and intramedullary nail group （（5. 09±2. 49） months） （P〈0.05）, and there was no significant difference between plate group and intramedullary nail group （P〉0.05）. The scores of shoulder joint function were （31.08 ± 5.12）, （29.91± 3.74） and （28. 95 ± 4. 12） in plate group, intramedullary nail group and external fixation group, showing no significant differences among three groups （P〉0.05）. The score of elbow joint function was 83.00± 14.40 in plate group, higher than that in external fixation group （73. 35± 16. 40） （P〈0.05）, and there was no significant difference between the other groups （P〈0.05）. External fixation group had no postoperative fracture nonunion, plate group had 2 cases of delayed healing of fracture and 5 cases of screw loosening, and intramedullary nail group had 3 cases of pseudarthrosis and 2 cases of delayed healing of fracture with infection. The incidences of postoperative complications were 29. 17%, 22. 73% and 0 in plate group, intramedullary nail group and external fixation group,