接骨板螺钉与髓内钉固定在肱骨干骨折中的应用

目的比较接骨板螺钉与髓内钉固定对闭合性肱骨干骨折的治疗效果。方法 2004年1月至2008年12月,86例闭合性肱骨干骨折患者分别采取接骨板螺钉与髓内钉手术内固定治疗。接骨板螺钉组48例（男31例,女17例）,平均年龄35.6岁（17～65岁）,骨折分型采用AO分型：A型22例,B型16例,C型10例。髓内钉组38例（男26例,女12例）,其中1例为双侧肱骨干骨折,平均年龄32.5岁（22～56岁）,A型15例,B型17例,C型6例。比较两组手术时间、手术出血量、骨折愈合时间、肩关节功能和并发症情况,进行回顾性分析。结果髓内钉组在手术时间与出血量上皆明显少于接骨板螺钉组,两者具有明显差异。而在骨折愈合时间、肩关节功能方面无统计学差异。接骨板螺钉组出现骨折不愈合而内固定失效1例。两组出现术中桡神经损伤各1例,皆经保守治疗后神经功能完全恢复。结论接骨板螺钉与髓内钉固定的治疗效果并无明显差异。解剖锁定接骨板髓外固定的适应证扩大至肱骨远近端近关节处骨折。治疗效果更多取决于术者的经验、手术条件和骨折类型。

Comparative study of humeral shaft fracture fixation:plates versus intramedullary nails

Objective To compare clinical outcomes of intramedullary nail（IMN） and plates for the management of humeral shaft fracture.Methods From January 2004 to December 2008,86 patients with close fracture of humeral shaft underwent internal fixation operation with IMN（38 cases） or plates（48 cases）.Clinical outcome measurements included operation time,blood loss,fracture healing,shoulder function,and complications.Results There were significant difference in operation time and blood loss between the two groups,but not in fracture healing and shoulder function. There was 1 fracture ununion in plate group.There was 1 radial nerve palsy both in plate and IMN groups,and recovered completely after conservative treatment.Conclusion There is no significant difference in clinical outcome between plates and IMNs.The advent of locking-plates has made it possible to fix proximal and distal fracture of humeral shaft.The ex- perience of orthopedists,the operation conditions and fracture type are key factors of prognosis.