钢板与髓内钉治疗肱骨干骨折的临床疗效比较  

作　　者：胡晓春[1] 张兴祥[1] 

机构地区：[1]张家港市第一人民医院骨科,江苏215600

出　　处：《当代医学》2015年第32期19-21,共3页Contemporary Medicine

摘　　要：目的比较切开复位钢板固定自体骨移植和闭合复位髓内钉治疗肱骨干闭合骨折的临床疗效。方法选取应用钢板和髓内钉治疗肱骨干闭合骨折患者共53例,分为切开复位钢板固定及自体骨移植28例(A组)和闭合复位顺形髓内钉25例(B组)。对2组患者手术时间、术中出血量、骨折愈合时间、肩关节功能、术后并发症等指标进行比较。结果所有病例均获得随访,A组骨折延迟愈合1例,骨不连1例,医源性桡神经麻痹3例,经对症治疗后均痊愈,达到骨性愈合;B组肩关节疼痛4例,医源性桡神经麻痹1例,经对症治疗后均痊愈。A组的手术时间、术中出血量均显著多于B组,差异有统计学意义(P<0.05);2组的骨折愈合时间差异无统计学意义;远期疗效按Neer评分标准评定,A组的评分显著高于B组,差异有统计学意义(P<0.05);2组优良率和术后并发症差异均无统计学意义。结论闭合复位髓内钉治疗肱骨干闭合骨折是较为理想的手术方法,具有固定可靠、操作简单、桡神经干扰小、不破坏骨折处血肿、手术创伤小及出血少等优点,通过严格地遵守操作规程,可预防和减少术后并发症的发生。Objective To compare the clinical effects of open reduction with plate fixation and autogenous bone graft and closed reduction with intramedullary nailing for closed humeral shaft fractures. Methods 53 patients with closed humeral shaft fractures were treated with plate or intramedullary nailing. They were divided into 2 groups： 28 cases were treated with plate fixation and autogenous bone graft （group A） and 25 cases with closed reduction with antegrade intramedullary nailing （group B）. We recorded and analyzed the following aspects： the operative time, the volume of blood losing, fracture healing time, the shoulder functions and postoperative complications. Results All cases were followed-up. In group A, there were 1 cases with delayed union, 1 case with nonunion and 3 cases of iatrogenic radial nerve palsy. All patients were recovered and obtained osseous healing after treatment. In group B, there were 4 cases with shoulder pain, 1 case with iatrogenic radial nerve palsy. All cases were healed after corresponding treatment. The operative time and the volume of blood losing in group A were more than group B, and the differences were statistically significant （P〈0.05）. There was no obvious difference in the fracture healing time. Neer scores in group A were more than group B, and the differences were statistically significant （P〈0.05）. There were no significant differences between the 2 groups regarding excellent and good rate or postoperative complications. Conclusion Closed reduction with antegrade intramedullary nailing is the ideal operative method of closed humeral shaft fractures. It has the advantage in firm fixation, simple operation, less interference for the radial nerve, unbroken hematoma of fracture site, minimal operative trauma and less blood lose. The complications can be prevented and diminished by the strict operation proceduce.

关 键 词：肱骨干骨折 钢板固定 髓内钉 植骨 

分 类 号：R687.3[医药卫生—骨科学]