带锁髓内钉与锁定加压钢板内固定治疗肱骨干骨折的随机对比研究

目的前瞻性对比研究带锁髓内钉和带锁加压钢板(LCP)治疗肱骨干骨折的临床效果。方法随机将49例分成两组(髓内钉28例;LCP组21例)。患者全部为新鲜肱骨干骨折,骨折部位距肱骨外科颈至少3cm,距尺骨鹰嘴大于5cm。临床疗效评价包括手术时间、出血量、骨折愈合情况、桡神经恢复、感染和肘关节、肩关节不适症状,影像学评价包括骨折力线、愈合时间、延长愈合和不愈合的发生率。结果平均随访1.5年。LCP组19例(90.5)骨折在16周后愈合,髓内钉组24例(85.7)在16周后愈合(P=0.70)。肩关节疼痛和肩关节活动受限在髓内钉组发生明显(P<0.05),而LCP组未发现这种情况。LCP组肘关节的活动范围明显减少(P<0.05),尤其是肱骨干远端1/3骨折患者。两组总并发症发生率比较无明显差异。结论对于需要手术治疗的肱骨干骨折,髓内钉和LCP都能使骨折稳定以达到最终愈合。

Humeral Shaft Fracture Fixation:Intramedullary Nails Versus LCP Plates

Objective To compare the clinical and radiographic results for locked intramedullary nails(IMN) and locking compression plates(LCP) used in the treatment of humeral diaphyseal fractures.Methods The 49 patients were randomizedly divided into two study groups:those treated by intramedullary nailing(IMN group,n=28) and those treated by LCP plating(LCP group,n=21).Fractures of the diaphysis were defined as being at least three centimeters distal to the surgical neck and at least five centimeters proximal to the olecranon fossa.Intervention treatment was performed either with locking antegrade intramedullary humeral nails or with 4.5-millimeter LCP.Main outcome measurements:the clinical outcome measurements included operation time,blood loss,fracture healing,radial nerve recovery,infection,and elbow and shoulder discomfort and the radiographic measurements included fracture alignment,time to healing,delayed union,and nonunion.Results Follow-up averaged eighteen months.Nineteen fractures(90.5%) in the LCP group were healed by sixteen weeks versus twenty-four fractures(85.7%) in the IMN group(P=0.70).Shoulder pain and a decrement in shoulder range of motion(ROM) were significant associated with IMN(P<0.05),but not with LCP.A decrease in elbow ROM was significantly associated with LCP(P<0.05),especially for fractures of the distal third of the diaphysis,whereas elbow pain was not(P>0.05).The sum of other complications demonstrated nearly equal prevalence for both treatment groups.Conclusion Both intramedullary nailing and compression plating provide predictable methods for achieving fracture stabilization and ultimate healing for patients requiring surgical treatment of a humeral shaft fracture.