三种内固定治疗上肢长骨干骨折的临床比较研究

目的观察天鹅记忆接骨器(swan-likememoryconnector,SMC)治疗上肢长骨干骨折的疗效,并与加压接骨板(dynamiccompressiveplate,DCP)和带锁髓内针(lockedintramedullarynail,LIN)进行临床对比研究。方法随机选择1997年8月～2001年8月入院的新鲜上肢长骨干骨折148例,分别采用SMC(49例)与DCP(50例)、LIN(49例)进行内固定治疗,术后常规抗炎治疗1周,定期拍片并随访患肢功能恢复情况。结果SMC组的手术时间明显低于LIN组与DCP组(P<0.05),三组伤口感染率无差异。SMC组骨愈合时间和骨不连发生率显著短于DCP组和LIN组(P<0.05),而术后功能优良率高于DCP组和LIN组。在SMC固定下,骨折愈合直接由解剖型或类解剖型的骨样骨板状直接替代连接,固定段无应力遮挡和骨质疏松。结论SMC是治疗上肢长骨干骨折的有效方法,优于DCP和LIN。SMC的几何构形和力学特性有利于骨折愈合。在本器固定下,可能存在一种新的尚未被认知的骨折愈合方式。

Effects of three kinds of internal fixation in treatment of long bone fractures of upper extremity:a clinical comparison

Objective To compare the clinical effects of swan like memory connector (SMC), dynamic compressive plate (DCP) and locked intramedullary nail (LIN) in treatment of humeral fractures. Methods 148 cases of fresh long bone fracture of upper extremities, admitted from January 1995 to December 2001, were treated randomly with one of the 3 internal fixations. 49 cases were stabilized with SMC, 50 cases DCP, and 49 cases LIN. After operation, regular anti inflam matory therapy was conducted for 1 week but no external fixation was employed for the treated limbs, and the healing process of their fractures was followed up regularly by radiography. Results The operative duration and hospitalization expenditure for SMC group were significantly reduced compared with those for DCP and LIN groups (P < 0.05). The fracture healing time for SMC group was significantly shorter than that for DCP and LIN groups (P< 0.05). The functional results in SMC group were superior to those in DCP and LIN groups. The fractures in SMC group healed at the primary stage. Neither external callus nor osteoporosis beneath the SMC body was found in SMC group. Conclusions The internal fixation by swanlike memory connector is an effective method for treating the long bone fractures in the upper extremiby, and better than that by DCP and LIN. The unique mechanical characteristic and geometric frame of SMC exert less interruption with the growth of cortical bone and facilitate fracture healing. There may be a new mode of fracture healing which needs further study in SMC fixation.