微创钢板接骨术和交锁髓内钉内固定术治疗肱骨干骨折的疗效比较  

Comparison of the curative effect of minimally invasive plate osteosynthesis and antegrade locking intramedullary nail internal fixation in the treatment of humeral shaft fractures

作　　者：许志贤[1] 何武兵[1] 柯铁[1] 张旭鸣[1] 张永发 Xu Zhixian;He Wubing;Ke Tie;Zhang Xuming;Zhang Yongfa(Department of Emergency,Provincial Clinical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院急诊外科,福州350001

出　　处：《创伤外科杂志》2022年第3期192-197,共6页Journal of Traumatic Surgery

基　　金：福建省自然科学基金面上项目(2020J011099)。

摘　　要：目的比较微创钢板接骨术(MIPO)与顺行交锁髓内钉(LIN)内固定术治疗肱骨干骨折的效果。方法回顾性分析2013年2月—2020年5月福建省立医院急诊外科收治的66例新鲜肱骨干骨折患者临床资料,32例采用MIPO治疗(微创钢板组),34例采用闭合复位顺行LIN内固定治疗(髓内钉组)。微创钢板组男性19例,女性13例;年龄28~62岁,平均45.0岁;致伤原因:道路交通伤14例,高处坠落伤10例,摔伤8例。髓内钉组男性20例,女性14例;年龄26~63岁,平均43.3岁;致伤原因:道路交通伤15例,高处坠落伤10例,摔伤9例。比较两组手术时间、术中出血量、住院时间、骨折愈合时间、末次随访时肩关节功能Neer评分与肘关节功能Mayo评分以及并发症情况。结果66例术后均获得随访,时间12~15个月,平均13.2个月。微创钢板组和髓内钉组手术时间分别为(71.1±8.4)min和(72.5±7.9)min(P>0.05),术中出血量分别为(186.6±23.9)mL和(223.1±23.9)mL(P<0.05),住院时间分别为(8.7±1.6)d和(9.1±1.4)d(P>0.05),骨折愈合时间分别为(12.2±1.7)周和(15.4±1.8)周(P<0.05)。术后12个月微创钢板组和髓内钉组肩关节功能Neer评分分别为(90.8±4.1)分和(87.1±3.0)分(P<0.05),肘关节功能Mayo评分分别为(94.2±2.2)分和(94.2±3.6)分(P>0.05)。术后并发症:髓内钉组并发切口感染1例,微创钢板组未并发切口感染,差异无统计学意义(P>0.05);髓内钉组并发肩关节痛4例,微创钢板组无一例出现肩关节痛(P<0.05);髓内钉组并发桡神经损伤2例,微创钢板组1例(P>0.05)。结论MIPO与顺行LIN内固定术均可用于治疗肱骨干骨折。应用MIPO技术骨折愈合时间更短、术后肩关节功能更优。Objective To compare the therapeutic effect of minimally invasive plate osteosynthesis(MIPO)and antegrade locking intramedullary nail(LIN)in the treatment of humeral shaft fractures.Methods The clinical data of 66 fresh humeral shaft fracture patients admitted to the Emergency Department of Fujian Provincial Hospital from Feb.2013 to May 2020 were retrospectively analyzed.Thirty-two cases were treated with minimally invasive plate osteosynthesis(minimally invasive plate group),and 34 cases were treated with closed reduction and antegrade locking intramedullary nailing(locking intramedullary nail group).In the minimally invasive plate group,there were 19 males and 13 females;the age ranged from 28 to 62 years,with an average of 45.0 years;the causes of injury:14 cases of road traffic injury,10 cases of falling from height,and 8 cases of falling injury.In the locking intramedullary nail group,there were 20 males and 14 females;the age ranged from 26 to 63 years,with an average of 43.3 years;the causes of injury:15 cases of road traffic injury,10 cases of falling from height,and 9 cases of falling injury.The operation time,intraoperative blood loss,hospital stay,fracture healing time,Neer score of shoulder joint function,Mayo score of elbow joint function and complications at the last follow-up were compared between the two groups.Results All 66 cases were followed up for 12 to 15 months(mean,13.2 months).The operation time of the minimally invasive plate group and the locking intramedullary nail group was(71.1±8.4)minutes and(72.5±7.9)minutes,respectively(P>0.05),the intraoperative blood loss was(186.6±23.9)mL and(223.1±23.9)mL,respectively(P<0.05),the length of hospital stay was(8.7±1.6)days and(9.1±1.4)days,respectively(P>0.05),and the fracture healing time was(12.2±1.7)weeks and(15.4±1.8)weeks,respectively(P<0.05).At 12 months after operation,the Neer scores of shoulder joint function in the minimally invasive plate group and the locking intramedullary nail group were(90.8±4.1)points and(87.1±3.0)point

关 键 词：肱骨干骨折 微创钢板接骨术 交锁髓内钉 内固定 

分 类 号：R683.41[医药卫生—骨科学]