髓内钉与钢板治疗肱骨投弹骨折的对比  

Interlocking intramedullary nail versus locking plate for throwing humeral fractures

作　　者：卢全忠 张扩 蔡程名 沈林华 史本海 安薛 宋涛 王若飞 LU Quan-zhong;ZHANG Kuo;CAI Cheng-ming;SHEN Lin-hua;SHI Ben-hai;AN Xue;SONG Tao;WANG Ruo-fei(Department of Orthopaedics,The970 th Hospital of PLA Joint Logistic Sport Force,Yantai 264000,China;People's Hospital of Fushan Area of Yantai City,Yantai265500,China)

机构地区：[1]中国人民解放军联勤保障部队第九七〇医院创伤骨科,山东烟台264000 [2]烟台市福山区人民医院骨科,山东烟台265500

出　　处：《中国矫形外科杂志》2020年第20期1849-1852,共4页Orthopedic Journal of China

摘　　要：[目的]比较带锁髓内钉与锁定加压钢板治疗肱骨投弹骨折患者的临床疗效。[方法]2010年1月~2017年1月83例肱骨投弹骨折患者纳入本研究,依据医患沟通结果,38例采用带锁髓内钉固定,45例采用锁定钢板固定。比较两组围手术期、随访和影像资料。[结果]术中桡神经损伤髓内钉组为0/38,钢板组为9/45,差异有统计学意义(P<0.05)。髓内钉组切口长度和术中出血量显著优于钢板组(P<0.05);术后切口并发症髓内钉组为0/38,钢板组为7/45,差异有统计学意义(P<0.05)。髓内钉组术后开始主动活动时间和完全负重活动时间显著早于钢板组(P<0.05)。随术后时间推移,两组患者Mayo评分和Neer评分均显著增加,术后相应时间点,两组间Mayo肘关节评分差异无统计学意义(P<0.05),但是髓内钉组Neer肩关节评分均显著低于钢板组(P<0.05)。影像显示髓内钉组骨折愈合时间显著早于钢板组(P<0.05),髓内钉组1/38有影像肩峰下撞击征象。[结论]带锁髓内钉与锁定加压钢板均为治疗肱骨投弹骨折的可靠性方法。髓内钉内固定具有手术创伤小、并发症少的优势,但有额外肩损伤的风险。[Objective]To compare the clinical outcomes of interlocking intramedullary nail versus locking plate for throwing humeral fractures.[Methods]From January 2010 to January 2017,a total of 83 patients with throwing humeral fractures were enrolled in this study.Based on the results of patient-doctor communication,38 patients had closed reduction and internal fixation with interlocking intramedullary nail,while the remaining 45 patients underwent open reduction and internal fixation with locking plate.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]The occurrence of radial nerve injury during operation was of 0/38 in the nail group,whereas 9/45 in the plate group,which proved of statistical significance(P<0.05).The nail group was significantly superior to the plate group in incision length and intraoperative blood loss(P<0.05).In addition,the incision complication happened in 0/38 of the nail group,whereas 7/45 of the plate group,which also was statistically significant(P<0.05).The Mayo and Neer scores significantly increased over time in both groups(P<0.05).Although no statistically significant differences in Mayo score for elbow function were noticed between them,the nail group was inferior to the plate group in Neer score for shoulder function at all time points postoperatively(P<0.05).With regard to radiographic assessment,the nail group got bony healing significantly earlier than the plate group(P<0.05),however,1 patient in the nail group had radiographic finding of subacromial impingement.[Conclusion]Both interlocking intramedullary nails and locking plate are reliable internal fixations for the throwing humeral fractures.By comparison,the intramedullary nail has advantages of minimizing surgical trauma and reducing surgical complications,whereas disadvantage of additional risk of shoulder impairment.

关 键 词：投弹骨折 带锁髓内钉 锁定钢板 内固定 

分 类 号：R683.42[医药卫生—骨科学]