摘要
目的 比较锁定加压钢板（locking compression plate,LCP）和带锁髓内钉（locked intramedullary nail,IMN）内固定治疗B、C型肱骨干骨折的疗效。方法 回顾性分析2010年1月-2012年1月收治的46例AO分型为B、C型的肱骨干骨折患者临床资料,其中22例采用LCP内固定治疗（LCP组）,24例采用IMN内固定治疗（IMN组）。两组患者性别、年龄、致伤原因、侧别、骨折部位、骨折分型、合并伤及受伤至手术时间等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。术后随访行临床检查和影像学评估,根据Neer肩关节评定标准和Mayo肘关节评定标准评价肩、肘关节功能。结果 LCP组手术时间和术中出血量显著多于IMN组（P〈0.05）;两组住院时间比较差异无统计学意义（t=0.344,P=0.733）。两组患者均获随访,随访时间12～24个月,平均16.8个月。术后6个月,LCP组1例、IMN组2例发生骨不连,骨折愈合率分别为95.5%（21/22）和91.7%（22/24）,比较差异无统计学意义（χ2=0.000,P=1.000）。除骨不连患者外,LCP组骨愈合时间为（11.77±0.75）周,IMN组为（11.38±0.82）周,比较差异无统计学意义（t=1.705,P=0.095）。术后两组桡神经损伤（LCP组4例、IMN组无）、肩部撞击（LCP组无、IMN组6例）发生率比较差异均有统计学意义（P〈0.05）;浅表性感染（LCP组1例、IMN组无）、医源性骨折（LCP组1例、IMN组2例）发生率比较差异均无统计学意义（P〉0.05）。术后1年,两组肩、肘关节功能评价比较,差异均无统计学意义（P〉0.05）。结论 采用LCP和IMN内固定治疗B、C型肱骨干骨折均可取得较好疗效。使用LCP时需注意避免损伤桡神经;使用IMN时需注意将钉尾埋入大结节皮质并保护肩袖,以免发生肩部撞击。
Objective To compare the effectiveness between locking compression plate （LCP） and locked intramedullary nail （IMN） for humeral shaft fractures of types B and C. Methods Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases （LCP group）, and IMN in 24 cases （IMN group）. There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups （P 〉 0.05）. The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. Results The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group （P 〈 0.05）. There was no significant difference All patients were followed up 16.8 months on average （range in hospitalization time between 2 groups （t=0.344, P=0.733）. 12-24 months）. At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% （21/22） in LCP group and 2 91.7% （22/24） in IMN group, showing no significant difference （Z =0.000, P=1.000）. Except for nonunion patients, the bone healing time was （11.77±0.75） weeks in LCP group and （11.38 ±0.82） weeks in IMN group, showing no significant difference （t=1.705, P=0.095）. Between LCP and IMN groups, significant differences were found in radial nerve injury （4 cases vs. 0 case） and impingement of shoulder （0 case vs. 6 cases） （P 〈 0.05）, but no significant difference in superficial infection （1 case vs. 0 case） and iatrogenic fracture （1 case vs. 2 cases） （P 〉 0.05）. There was no significant difference in shoulder function and elbow function at 1 year after operation between 2 groups （P 〉 0.05）. Conclusion LCP fixation and IMN fixation for humeral shaft fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第12期1457-1461,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肱骨干骨折
锁定加压钢板
带锁髓内钉
临床疗效
Humeral shaft fracture Locking compression plate Locked intramedullary nail Effectiveness
