肱骨干骨折手术与非手术治疗的比较  

Comparative results of non-operative and operative treatment of humeral shaft fractures

作　　者：张伯松[1] 李文毅[2] 刘兴华[1] 危杰[1] 贺良[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,北京100035 [2]河北省人民医院骨科,石家庄050051

出　　处：《北京大学学报（医学版）》2017年第5期851-854,共4页Journal of Peking University:Health Sciences

摘　　要：目的:比较肱骨干骨折手术与非手术治疗方法的临床疗效,以期指导临床选择。方法:连续入选2005年3月至2012年10月间有完整随访资料的患者252例,根据治疗方法的不同将患者分为保守治疗组和手术内固定组,其中保守治疗组76例使用石膏或小夹板固定骨折,手术内固定组176例使用切开复位钢板或髓内针固定骨折。对两组间并发症发生率、骨折愈合时间、骨折愈合率、Constant-Murley肩关节功能评分和Mayo肘关节功能评分等参数进行比较。结果:平均随访(31.24±20.06)个月。两组数据在年龄、开放骨折数量、骨折部位和AO(Arbeitsgemeinschaft für Osteosynthesefragen)分类方面差异没有统计学意义。骨折愈合率:保守治疗组96.1%(73/76),手术内固定组97.7%(172/176),P=0.46;骨折愈合时间:保守治疗组(10.24±2.93)周,手术内固定组(10.69±2.51)周,P=0.22;并发症发生率:保守治疗组5.3%(4/76例),手术内固定组15.3%(27/176例),P=0.025;其中骨折不愈合率:保守治疗组3.95%(3/76),手术内固定组2.3%(4/176),P=0.43;桡神经损伤:保守治疗组0%(0/76),手术内固定组5.7%(10/176),P=0.035;骨劈裂:保守治疗组0%(0/76),手术内固定组1.7%(3/176),P=0.556;肘僵硬:保守治疗组1.3%(1/76),手术内固定组0.6%(1/176),P=1.000;肩痛:保守治疗组0%(0/76),手术内固定组5.1%(9/176),P=0.061。Constant-Murley肩关节功能评分:保守治疗组(97.37±4.94)分,手术内固定组(96.34±6.88)分,P=0.24;Mayo肘关节功能评分:保守治疗组(99.80±1.72)分,手术内固定组(99.49±2.73)分,P=0.36。结论:肱骨干骨折保守治疗与手术治疗的疗效相当,但并发症少。Objective: To compare the difference between non-operative and operative treatment of humeral shaft fractures. Methods: From March 2005 to October 2012,252 cases of humeral shaft fractures were treated and were adequately followed up. According to the treatment methods,the patients were divided into 2 groups: the non-operative group and the operative group. In the non-operative group,there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with internal fixation either by plating or by nailing in the operative group. The follow-up parameters included:fracture healing rate,fracture union time,complications rate,Constant-Murley shoulder score and Mayo elbow score. Results: The mean follow-up period was( 31. 24 ± 20. 06) months( ranging 6 to 103months). There were no statistical differences in age,open fracture number,fracture site and Arbeitsgemeinschaft für Osteosynthesefragen( AO) classification between the non-operative group and the operative group. The fracture healing rate: the non-operative group: 96. 1%( 72/76),the operative group:97. 7%( 172/176),P = 0. 46; the fracture union time: the non-operative group:( 10. 24 ± 2. 93) weeks,the operative group:( 10. 69 ± 2. 51) weeks,P = 0. 22; the complication rate: the non-operative group:5. 3%( 4/76),the operative group: 15. 3%( 27/176),P = 0. 03. The complications included: nonunion: the non-operative group: 3. 95%( 3/76),the operative group: 2. 3%( 4/176),P = 0. 434; radial nerve palsies: the non-operative group: 0%( 0/76),the operative group: 5. 7%( 10/176),P = 0. 035;bone split: the non-operative group: 0%( 0/76),the operative group: 1. 7%( 3/176),P = 0. 556; elbow stiffness: the non-operative group: 1. 3%( 1/76),the operative group: 0. 6%( 1/176),P = 1. 000;shoulder pain: the non-operative group: 0%( 0/76),the operative group: 5. 1%( 9/176),P = 0. 061.The Constant-Murley shoulder score: the non-operative group: 97. 37 ± 4. 94, the operative group:96. 34 ± 6. 88,P = 0. 244. The Mayo elbow score: the non-operati

关 键 词：肱骨干骨折 石膏 小夹板 钢板 带锁髓内针 

分 类 号：R683.41[医药卫生—骨科学]