可膨胀髓内钉与锁定加压钢板治疗肱骨干骨折的疗效比较  

Comparison of expandable intramedullary nail versus locked compression plate for treatment of humeral shaft fractures

作　　者：王陶然[1] 袁志[1] 裴国献[1] 李岩[1] 罗鸣[1] 龙江[1] 毕龙[1] 强磊[1] 张肖在 郑天雷[1] 隋天棋 宋晨[1] 

机构地区：[1]第四军医大学西京医院骨科,西安710032

出　　处：《中华创伤骨科杂志》2017年第7期566-571,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较可膨胀髓内钉（EIMN）与锁定加压钢板（LCP）治疗肱骨干骨折的疗效。方法回顾性分析2012年5月到2016年2月期间收治的44例肱骨干骨折患者资料，男26例，女18例；年龄23—66岁，平均41．5岁。骨折按AO分型：12-A型22例，12-B型22例。根据内固定方式不同分为2组：22例患者采用EINM治疗（EINM组），平均（41．3±11．7）岁；22例患者采用LCP治疗（LCP组），平均年龄（41．6±10．3）岁。比较分析两组患者术中出血量、手术时间、住院时间、骨折愈合时间、骨折愈合率、末次随访时Constant评分及Mayo评分和总并发症发生情况。结果EIMN组和LCP组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。44例患者术后获10—18个月（平均12个月）随访。E1MN组患者的术中出血量[（76．4±18．7）mL]、手术时间[（69．1±13．2）min]、切口长度[（5．8±1．5）cm]和骨折愈合时间[（13．2±8．4）周]，均优于LCP组患者[（138．6±39．4）mL、（96．4±14．2）min、（8．5±1．4）CE、（18．4±6．6）周]，差异均有统计学意义（P〈0．05）。EIMN组和LCP组患者总并发症发生率分别为18．2％（4／22）、50．0％（11／22），差异有统计学意义（P〈0．05）。两组均无一例患者出现深部感染、肩关节疼痛等并发症。结论与切开复位的LCP相比，EIMN治疗肱骨干的42．A型和42．B型骨折具有术中出血量少、手术时间短、愈合时间短及并发症少的优点，两种治疗方式住院时间及最终肩肘关节功能恢复效果相当。Objective To compare the effectiveness of expandable intramedullary nail （EIMN） versus locked compression plate （LCP） in the treatment of humeral shaft fractures of AO types A and B. Methods The clinical data were retrospectively analyzed and compared of the 44 humeral shaft fractures which had been treated between May 2012 and February 2016. There were 26 men and 18 women, from 23 to 66 years of age （average, 41.5 years） . By AO classification, 22 cases were type 12-A and 22 type 12-B. EINM was used in 22 patients with an average age of 41.3 ± 11.7 years and LCP in 22 ones with an average age of 41.6 ± 10.3 years. The 2 groups were compared in terms of intraoperative blood loss, operative time, hospital stay, union time, union rate, Constant and Mayo scores at the final follow-ups, and complications as well. Results The 2 groups were compatible without significant differences in the preoperative demo- graphic data （ P 〉 0.05）. All the 44 patients were followed up for 10 to 18 months （average, 12 months）. The intraoperative blood loss （76.4 ± 18.66 mL）, operative time （69. 1 ± 13.2 min）, incision length （5.8 ± 1.5 cm） and union time （13.2 ± 8.4 w） in the EIMN group were significantly better than those in the LCP group （138.6 ± 39.4 mL, 96.4 ± 14.2 rain, 8.5 ± 1.4 cm and 18.4 ± 6.6 w, respectively） （ P 〈 0. 05）. There was also a significant difference between the 2 groups in the total complication rate[18.2% （4/22） versus 50.0% （ 11/22） ] （ P 〈 0.05）. No deep infection or should pain was observed in either group. Conclusions In the treatment of humeral shaft fractures of AO types 42-A and 42-B, compared with LCP, EIMN may have ad- vantages of less intraoperative blood loss, operative time, union time and complications. The 2 methods are similar in hospital stay and final functional recovery of the should joint.

关 键 词：肱骨骨折 骨折固定术 内 骨钉 骨板 

分 类 号：R687.3[医药卫生—骨科学]