Chapman J R, Henley M B, Agel J, Benca P J
Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle 98104, USA.
J Orthop Trauma. 2000 Mar-Apr;14(3):162-6. doi: 10.1097/00005131-200003000-00002.
To compare the clinical and radiographic results for locked intramedullary (IM) nails and plates used in the treatment of humeral diaphyseal fractures.
Prospective randomization by sealed-envelope technique of eighty-four patients into two study groups: those treated by intramedullary nailing (IMN group; n = 38) and those treated by compression plating (PLT group; n = 46).
Patients admitted consecutively to a university-affiliated Level I trauma center.
PATIENT/PARTICIPANTS: All skeletally mature patients admitted to Harborview Medical Center with acute humeral shaft fractures requiring surgical stabilization. Fractures of the diaphysis were defined as being at least three centimeters distal to the surgical neck and at least five centimeters proximal to the olecranon fossa.
Treatment with locking antegrade intramedullary humeral nails (Russell-Taylor design [Smith and Nephew Richards]) or with 4.5-millimeter dynamic compression and limited contact dynamic compression plates (AO design [Synthes]).
Clinical outcome measurements included fracture healing, radial nerve recovery, infection, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion.
Follow-up averaged thirteen months. Forty-two fractures (93 percent) in the PLT group were healed by sixteen weeks versus thirty-three fractures (87 percent) in the IMN group (p = 0.70). Shoulder pain and a decrement in shoulder range of motion (ROM) were significant associations with IMN (p = 0.007 for both variables) but not with PLT. A decrement in elbow ROM was significantly associated with PLT (p = 0.03), especially for fractures of the distal third of the diaphysis, whereas elbow pain was not (p = 0.123). The sum of other complications demonstrated nearly equal prevalence for both treatment groups.
For patients requiring surgical treatment of a humeral shaft fracture, intramedullary nailing and compression plating both provide predictable methods for achieving fracture stabilization and ultimate healing.
比较锁定髓内钉和钢板治疗肱骨干骨折的临床及影像学结果。
采用密封信封技术将84例患者前瞻性随机分为两个研究组：髓内钉固定组（IMN组；n = 38）和加压钢板固定组（PLT组；n = 46）。
连续收治于某大学附属一级创伤中心的患者。
患者/参与者：所有骨骼成熟、因急性肱骨干骨折需手术稳定治疗而入住哈博维尤医疗中心的患者。骨干骨折定义为至少位于手术颈远端3厘米且鹰嘴窝近端至少5厘米处。
采用锁定顺行肱骨髓内钉（Russell-Taylor设计[史赛克公司]）或4.5毫米动力加压和有限接触动力加压钢板（AO设计[辛迪斯公司]）进行治疗。
临床观察指标包括骨折愈合、桡神经恢复、感染以及肘部和肩部不适。影像学测量指标包括骨折对线、愈合时间、延迟愈合和不愈合。
平均随访13个月。PLT组42例骨折（93%）在16周时愈合，而IMN组为33例骨折（87%）（p = 0.70）。肩部疼痛和肩部活动范围（ROM）减小与IMN显著相关（两个变量p均 = 0.007），但与PLT无关。肘部ROM减小与PLT显著相关（p = 0.03），尤其是骨干远端三分之一处的骨折，而肘部疼痛则不然（p = 0.123）。其他并发症的总和在两个治疗组中的发生率几乎相等。
对于需要手术治疗肱骨干骨折的患者，髓内钉固定和加压钢板固定均为实现骨折稳定和最终愈合的可预测方法。
