手术与功能支具对闭合性移位肱骨干骨折患者功能结局的影响  

Effects of surgery and functional braces on functional outcomes in patients with closed displaced hu-meral shaft fractures

作　　者：李欣 雷孝勇 康大为 Li Xin;Lei Xiaoyong;Kang Dawei(Dazhou Hospital of Integrated Traditional Chinese and Western Medicine,Dazhou 635000,China)

机构地区：[1]达州市中西医结合医院,635000

出　　处：《中华老年骨科与康复电子杂志》2024年第4期215-221,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：达州市2019年市级医学科研立项课题(2019021)。

摘　　要：目的本文旨在比较切开复位钢板内固定手术与非手术功能性支具治疗闭合性肱骨干骨折的疗效。方法前瞻性收集2018年10月至2021年1月进行闭合性肱骨干骨折治疗的82例患者纳入研究,女38例,男44例,年龄(49.0±17.4)岁。82例患者进行随机分配,38例接受切开复位和内板固定的手术治疗,44例接受功能性支具的非手术治疗。12个月时的手臂、肩部和手部残疾评分(DASH),范围0至100分,0表示无残疾,100表示极度残疾;最小的临床重要差异,10分。结果在随机分组的82例患者中78例完成了试验。13例分配到功能性支具的患者在12个月的随访期间接受了手术以促进骨折愈合。在12个月时,手术组的平均DASH评分为8.9(95%CI:4.2,13.6),支具组为12.0(95%CI:7.7,16.4)(组间差异,-3.1分;95%CI:-9.6,3.3;P=0.341)。分配到功能性支具的11例患者出现骨折不愈合。3例接受手术的患者出现了暂时性桡神经麻痹。结论在闭合性肱骨干骨折患者中,与非手术功能支具相比,内固定手术在12个月时并未显著改善功能结果。Objective This article aims to compare the efficacy of open reduction and internal plate fixation with non-surgical functional braces for the treatment of closed humeral shaft fractures.Methods Pro-spective collection 82 patients,mean age 48.9 years,38 women[46%],44 men[54%],Age(49.0±17.4),who un-derwent treatment for closed humeral shaft fractures at our hospital from October 2018 to January 2021,were randomly assigned surgical treatment with open reduction and internal plate fixation(n=38)or non-surgical treatment with functional braces(n=44).main results:Disability ofArm Shoulder and Hand(DASH)score at 12 months(range:0 to 100,with 0 being no disability and 100 being extremely disabled;minimal clinically impor-tant difference,10).Results Of the 82 patients randomized,78(95%)completed the trial.13(30%)patients as-signed to a functional brace underwent surgery to promote fracture healing during the 12-month follow-up.At 12 months,the mean DASH score was 8.9(95%CI,4.2 to 13.6)in the surgery group and 12.0(95%CI,7.7 to 16.4)in the brace group(between-group difference,-3.1 points;95%CI,-9.6 to 3.3;P=0.341).Nonunion oc-curred in 11 patients(25%)assigned to a functional brace.3 patients(8%)who underwent surgery developed transient radial nerve palsy.Conclusion In patients with closed humeral shaft fractures,internal fixation did not significantly improve functional outcomes at 12 months compared with nonoperative functional braces.

关 键 词：内固定手术 非手术功能支具 闭合性移位肱骨干骨折 结局 

分 类 号：R687.3[医药卫生—骨科学]