顺行旋入式髓内钉与锁定钢板治疗肱骨干骨折疗效比较  

Comparison between the Anterograde Screwing-type Intramedullary Nail and the Locking Plate for the Therapeutic Effect of Humeral Shaft Fractures

作　　者：尤微[1] 王大平[1] 熊建义[1] 

机构地区：[1]深圳市第二人民医院创伤骨科,深圳518035

出　　处：《中国现代手术学杂志》2010年第4期277-280,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较顺行旋入式髓内钉和锁定钢板系统治疗肱骨干骨折的临床疗效。方法对38例肱骨干骨折患者,采用顺行旋入式自锁髓内钉固定21例,锁定钢板系统内固定17例。结果 38例均获随访,平均18.6个月。旋入式自锁髓内钉组平均手术时间(47.90±4.98)min,桡神经损伤1例,骨折平均愈合时间(23.04±1.62)周,肩关节Constant评分平均(77.71±5.84)分,肘关节Mayo评分(91.33±1.73)分;锁定钢板系统组平均手术时间(62.64±4.71)min,桡神经损伤2例,骨折平均愈合时间(27.88±1.57)周,肩关节Constant评分(86.14±2.27)分,肘关节Mayo评分(92.44±2.29)分。治愈率均为100%。旋入式髓内钉组在手术时间、骨折愈合时间上短于锁定钢板组(P<0.01),但Con-stant肩关节评分较低(P<0.01),其他指标无统计学差异(P>0.05)。结论旋入式自锁髓内钉手术操作简单、时间短、损伤小、术中并发症少、骨折愈合快,适合稳定性骨折、非缺损性粉碎性骨折,但抗旋转及抗短缩方面不及锁定钢板系统,对非稳定性骨折、断端缺损性粉碎性骨折宜选择锁定钢板系统。Objective To compare the curative effect of anterograde screwing-type intramedullary nail and the locking plate on the treatment of humeral shaft fractures,and provide reference for the clinical application.Methods Thirty-eight fractures of humeral shaft patients were included.Twenty-one patients fixed with anterograde screwing-type intramedullary nails,and seventeen patients were fixed by locking plates.The two groups were compared for their operative procedures,operative complications,curative effect and indications.Results The patients were followed up for 18.6 months average.In the screwing-type group,the operation time averaged（47.90±4.98） minutes;the mean healing time was（23.04±1.62） weeks.There was 1 case complicated with radial nerve injury.Mean Constant Shoulder Score was（77.71±5.84）,the mean Mayo Elbow Score was（91.33±1.73）.In the locking plate group,the mean operation time and healing time was（62.64±4.71）min and（27.88±1.57）weeks respectively.There were 2 of radial nerve injuries.Mean Constant Shoulder Score and mean Mayo Elbow Score was（86.14±2.27）and（92.44±2.29）respectively.The healing rates were both 100%.The screwing-type group was better than the locking plate group in the operation time and the mean healing time（P0.01）,but the Constant Shoulder Score was lower（P0.01）.There was no significant difference between two groups in the other indexes.Conclusions The operation with anterograde screwing-type intramedullary nail is easier with fewer injuries and complications,which should be applied to the stable fractures without defects.The locking plate is more suitable for the unstable comminuted fractures with bone defects.

关 键 词：肱骨骨折 骨折内固定术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]