成人肱骨干骨折髓内钉与钢板内固定两种方法的比较

目的 对比带锁髓内钉与钢板两种内固定方法治疗肱骨干骨折的临床效果.方法 成人肱骨干骨折患者88例,分为带锁髓内钉组39例,钢板组49例.临床评价和影像学骨折愈合时间、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 术后随访4～44个月,平均13个月.平均临床愈合时间髓内钉组12.3周,钢板组13.4周;平均放射学骨折线消失时间髓内钉组9.9周,钢板组11.2周;术后感染率两组均为0;术后肩关节功能评分,髓内钉组优秀34例,良好5例,钢板组优秀49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.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.

Clinical analysis of humeral shaft fracture fixation: intramedullary nails versus plates

Objective To compare the clinical outcome of interlocking intramedullary nail with that of plate in treating of humeral shaft fractures. Methods Eighty-eight patients with humeral shaft fractures were treated surgically. Thirty-nine cases were treated with interlocking intramedullary nail(IIN) fixation,49cases were treated with plate fixation(PLT). Clinical outcome measurements included fracture healing, radial nerve injury, infection, shoulder function according to Neer's score and soft tissue engorgement. Results The average follow-up time was 13 months(4 months to 44 months). Forty-nine cases those were treated with PLT fixation ,the average time of healing was 13.4 weeks; 39 cases those were treated with IIN fixation ,the average time of healing was 12.3 weeks . 100% of patients had good to excellent postoperative shoulder function,.6 cases displayed postoperative radial never palsy in PLT group, but no case has iatrogenic injury in IIN group. Five cases displayed secondary postoperative radial never palsy in PLT group, and no case in IIN group. Four cases with swollen limbs persisted over 2 weeks in PLT group while 11 cases with swollen limbs persisted over 2 weeks in IIN group. Conclusions 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.