三种内固定方法治疗成年人肱骨远端骨折的临床疗效比较  

Comparison of the curative effects of three fixed methods in the management of distal humeral fractures in adults

作　　者：李秉斌[1] 

机构地区：[1]慈溪市人民医院骨科,浙江省慈溪315300

出　　处：《中国基层医药》2016年第15期2278-2281,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：比较三种内固定方法在治疗成年人肱骨远端骨折中的临床疗效。方法收集2012年1月至2015年12月慈溪市人民医院收治的成人肱骨远端骨折患者120例，按照随机数字表法将患者分为单钢板固定组、Y 型钢板固定组和双侧重建钢板固定组。主要观察指标为手术情况、术后肘功能恢复情况和术后并发症。结果三组骨折愈合时间差异有统计学意义[（99．48±11．81）d、（108．93±11．05）d 和（111．35±11．11）d，F ＝12．274，P ＝0．000]；单钢板固定组与 Y 型钢板固定组骨折愈合时间差异无统计学意义（t ＝0．979，P ＝0．331），但双侧重建钢板固定组骨折愈合时间显著较单钢板固定组和 Y 型钢板固定组缩短（t 值分别为3．696和4．632，P 值均为0．000）。术后3个月时，三组 Mayo 肘关节功能评分差异有统计学意义[（88．63±7．35）分、（79．98±6．06）和（79．60±6．54）分，F ＝12．274，P ＝0．000]；单钢板固定组与 Y 型钢板固定组 Mayo 肘关节功能评分差异无统计学意义（t ＝0．266，P ＝0．791）；但双侧重建钢板固定组 Mayo 肘关节功能评分显著较单钢板固定组和 Y 型钢板固定组增高（t 值分别为5．742和5．799，均 P ＜0．05．）。三组手术时间、术中出血量、内固定失败、切口感染、尺神经炎、骨化性肌炎和钢板松动率等差异均无统计学意义（均P ＞0．05）。结论双侧重建钢板固定更符合肱骨远端生物力学特点，有利于肘关节功能恢复。Objective To compare the curative effects of three fixed methods in the management of distal humeral fractures in adults.Methods From January 2012 to December 2015,120 adults patients with distal humeral fractures admitted to our hospital were enrolled in this prospectively study.According to the principle of random digital table,all patients were randomly signed into single plate fixation group,Y type plate fixation group or double plates fixation group.The primary outcomes included surgical approach,elbow function recovery and postoperative complica-tions.Results Significantly differences were observed among the three groups in fracture union time[（99.48 ± 11.81）d vs.（108.93 ±11.05）d vs.（111.35 ±11.11）d,F =12.274,P =0.000）];there was no difference in fracture union time between the single plate fixation group and Y type plate fixation group （t =0.979,P =0.331）. However,patients in double plates fixation group got a significantly shorter fracture union time when compared with the single plate fixation group or Y type plate fixation group （t =3.696,4.632,both P =0.000）.Significantly differences were observed among the three groups in Mayo elbow performance score three months after the operation[（88.63 ±7.35）points vs.（79.98 ±6.06）points vs.（79.60 ±6.5）points,F =12.274,P =0.000）].There was no difference in Mayo elbow performance score between the single plate fixation group and Y type plate fixation group （t =0.266, P =0.791）.However,the patients in the double plates fixation group got a significantly higher Mayo elbow perform-ance score （t =5.742,5.799,both P =0.000）.There was no difference among the three groups in operation duration,intraoperative bleeding volume,failure rate of internal fixation,surgical site infection,ulnar neuritis,myositis ossificans and loosening of the plate （all P 〉0.05）.Conclusion Double plates is more in line with the biomechanical characteristics of the distal humerus,and it is beneficial to the functional recovery of elbow joint

关 键 词：肱骨远端骨折 内固定方法 双侧重建钢板固定 Y 型钢板固定 单钢板固定 

分 类 号：R687.3[医药卫生—骨科学]