有限接触动力加压钢板与微创拉力螺钉治疗投弹骨折疗效比较  

LC-DCP Versus Minimally Invasive Lag Screw in Treatment of Throwing Fracture

作　　者：朱显科 吴望晟 左新成[2] 张伟旭[2] 黄昌林[2] 

机构地区：[1]第四军医大学附属西京医院骨科,陕西西安710032 [2]解放军150医院骨科,河南洛阳471000

出　　处：《现代生物医学进展》2017年第16期3095-3098,共4页Progress in Modern Biomedicine

基　　金：济南军区后勤立项课题(JN11L035)

摘　　要：目的:评价有限接触动力加压钢板与微创拉力螺钉固定治疗肱骨投弹骨折的临床疗效。方法:回顾性分析2013年12月至2016年2月收治的37例肱骨投弹骨折的临床资料。其中29例行切开复位钢板内固定治疗,8例行有限切开复位拉力螺钉固定。两组研究对象性别、年龄、入伍前受教育程度、受伤至手术时间等一般资料比较,无显著性统计学差异(p>0.05),术后定期行临床检查及X线检查,根据MEPS肘关节功能评分标准评价肘关节功能。结果:切开复位LC-DCP内固定组手术时间及术中出血显著多于有限切开拉力螺钉固定组(p<0.05);两组住院时间无统计学差异(t=1.615,P=0.127),两组患者均获得随访,随访时间9-36月,平均12月。术后6个月,两组骨折愈合率均为100%,无统计学差异,切开复位LC-DCP内固定组,骨折愈合时间9.93±3.05周,有限切开拉力螺钉固定组骨折愈合时间11.09±2.33周,比较无显著性差异(t=1.07,p=0.302)。术后桡神经挫伤(钢板内固定组2例,螺钉内固定组1例)和肘关节功能评价比较,两组无统计学差异(p>0.05)。两组术后均未出现内固定失效、感染、骨不连等并发症。结论:采用切开复位LC-DCP内固定及有限切开拉力螺钉固定治疗投弹骨折均可取得较好临床疗效,使用钢板内固定时注意避免过多破坏骨折断端血运和保护桡神经;使用螺钉内固定时需要注意术后肩肘关节支具保护6-8周,避免早期主动功能锻炼,导致内固定失效。Objective： To compare the effectiveness between LC-DCP and minimally invasive lag screw for humeral shaft fracture. Methods： Between December 2013 and February 2016, 37 patients with humeral shaft fractures were treated, and the clinical date were retrospectively analyzed. LC-DCP was used for internal fixation in 29 patients, and lag screw in 8 patients. There was no significant difference in gender, age, education background before joining the army and the time from injury to operation between 2 groups （p〉0.05）. The regular clinical examination and X radiography were done. Elbow function was evaluated by MEPS after surgery. Results： The operation time and intraoperative blood loss in LC-DCP group were significant more than those in lag screw group（p〈0.05）. There was no significant difference in hospitalization time between 2 groups（t=l.615, P=0.127）. All patients were followed up 12 months on average （range, 9-36 months）. At 6 months after operation, the bone healing rates of 2 groups were 100%, showing no significant difference. The bone healing time was （9.93±3.05 ） weeks in LC-DCP group and （ 11.09 ±2.33 ） weeks in lag screw group, showing no significant diference （t=l.07, p=0.302）. Between the 2 groups, no significant difference were found in radial nerve injury （2 cases in LC-DCP and 1 case in lag screw）and elbow function （p〉0.05）. There were no complications such as internal fixation failure, infection and bone nonunion after operation. Conclusion： LC-DCP and lag screw for humeral shaft fractures achieved satisfactory results. More attention should be paid to avoiding blood supply destroy and protecting radial nerve by fixation fo LC-DCP. Casts spanning the shoulder and elbow and no positive function training in early period of postoperation were necessary to decrease the rate of internal fixation failure.

关 键 词：投弹骨折 有限接触动力加压钢板 拉力螺钉 治疗 

分 类 号：R683[医药卫生—骨科学]