Osman N, Touam C, Masmejean E, Asfazadourian H, Alnot J Y
Service d'Orthopédie et Traumatologie, Hôpital Bichat, Paris.
Chir Main. 1998;17(3):195-206. doi: 10.1016/s0753-9053(98)80039-2.
The aim of this study was to examine the results of different modalities applied in the treatment of 104 fresh diaphyseal fractures of the adult humerus treated in the department between January 1994 and March 1997. These results were classified according to the criteria described by Stewart and Hundley. 32 patients (30.8%) were treated non-operatively using a sling and a moulded plaster splint. The type of treatment had to be changed in 12 of these patients due to 14 different complications that occurred during the course of non-operative treatment. Thus, 20 patients (62.5%) underwent non-operative treatment until fracture-union. The results in this group were: very good in 12 cases (60%), good in 5 cases (25%), fair in 3 cases (15%). 28 fractures were treated using plates and screws. 4 events (14%) occurred during in the post-operative period and, apart from 2 cases of non-union, the overall result in the 26 patients in whom the fracture united was: very good in 23 cases (88.5%) and good in 3 cases (11.5%). 22 patients (21.1%) underwent fixation using multiple flexible intramedullary wires via a supracondylar approach. Apart from one case of non-union, the final result in the 21 patients in whom the fracture united was: very good in 9 cases (42.8%), good in 9 cases (42.8%), fair in 2 cases (9.5%) and poor in 1 case (4.9%). 22 fractures were treated using an intramedullary Seidel nail. The final result in these patients was: very good in 11 cases (50%), good in 9 cases (41%) and poor in 2 cases (9%). The indications for treatment should be eclectic. Non-operative treatment remains the method of choice for undisplaced or minimally-displaced fractures or comminuted fractures with multiple parallel longitudinal fracture-lines over the middle-third, while surgical treatment is considered for displaced fractures and essentially depends upon the type and level of the fracture. Transverse and short oblique fractures are treated using a plate or a Seidel nail. Fractures with a third fragment require plate osteosynthesis. Multiple flexible intramedullary wires are used for segmental fractures or for diaphyseal fractures associated with fractures of the neck of the humerus. Comminuted fractures are realigned using an intramedullary Seidel nail or multiple flexible wires. As far as the site of fracture is concerned, those of the proximal and middle thirds of the humerus are well treated using an intramedullary nail or multiple wires or with a plate, while plating is most often the method of choice for fractures of the distal-third.
本研究的目的是探讨1994年1月至1997年3月间在该科室治疗的104例成人肱骨干新鲜骨折采用不同治疗方式的结果。这些结果根据Stewart和Hundley描述的标准进行分类。32例患者（30.8%）采用吊带和塑形石膏夹板进行非手术治疗。由于非手术治疗过程中出现14种不同并发症，其中12例患者的治疗方式不得不改变。因此，20例患者（62.5%）接受非手术治疗直至骨折愈合。该组结果为：12例（60%）非常好，5例（25%）良好，3例（15%）一般。28例骨折采用钢板螺钉治疗。术后发生4例（14%）事件，除2例骨不连外，26例骨折愈合患者的总体结果为：23例（88.5%）非常好，3例（11.5%）良好。22例患者（21.1%）经髁上入路采用多根弹性髓内针固定。除1例骨不连外，21例骨折愈合患者的最终结果为：9例（42.8%）非常好，9例（42.8%）良好，2例（9.5%）一般，1例（4.9%）差。22例骨折采用Seidel髓内钉治疗。这些患者的最终结果为：11例（50%）非常好，9例（41%）良好，2例（9%）差。治疗适应证应综合考虑。非手术治疗仍然是无移位或轻度移位骨折或中1/3有多个平行纵行骨折线的粉碎性骨折的首选方法，而对于移位骨折则考虑手术治疗，这主要取决于骨折的类型和部位。横行和短斜行骨折采用钢板或Seidel髓内钉治疗。有第三块骨块的骨折需要钢板内固定。多根弹性髓内针用于节段性骨折或与肱骨颈骨折相关的肱骨干骨折。粉碎性骨折采用Seidel髓内钉或多根弹性髓内针复位。就骨折部位而言，肱骨近1/3和中1/3的骨折采用髓内钉、多根髓内针或钢板治疗效果良好，而钢板固定通常是远1/3骨折的首选方法。
