van Middendorp J J, Kazacsay F, Lichtenhahn P, Renner N, Babst R, Melcher G
Eur J Trauma Emerg Surg. 2011 Jun;37(3):287-96. doi: 10.1007/s00068-011-0099-0. Epub 2011 Apr 1.
Although the non-operative management of closed humeral midshaft fractures has been advocated for years, the increasing popularity of operative intervention has left the optimal treatment choice unclear.
To compare the outcomes of operative and non-operative treatment of traumatic closed humeral midshaft fractures in adult patients.
A multicentre prospective comparative cohort study across 20 centres was conducted. Patients with AO type 12 A2, A3 and B2 fractures were treated with a functional brace or a retrograde-inserted unreamed humeral nail. Follow-up measurements were taken at 6, 12 and 52 weeks after the injury. The primary outcome was fracture healing after 1 year. Secondary outcomes included sub-items of the Constant score, general patient satisfaction, complications and cost-effectiveness parameters. Functions of the uninjured extremity were used as reference parameters. Intention-to-treat analysis was applied with the use of t-tests, Fisher's exact tests, Mann-Whitney U-tests and adjusted analysis of variance (ANOVA).
Forty-seven patients were included. The patient sample consisted of 23 women and 24 men, with a mean age of 52.7 years (range 17-86 years). Of the 47 cases, 14 were treated non-operatively and 33 operatively. The follow-up rate at 1 year was 81%. After 1 year, 11 fractures (100%) healed in the non-operative group and at least 24 fractures (≥89%) healed in the operative group [1 non-union patient (4%) and no data for 2 patients (7%)]. There were no significant differences in pain, range of motion (ROM) of the shoulder and elbow, and return to work after 6 weeks, 12 weeks and 1 year. Although operatively treated patients showed significantly greater shoulder abduction strength (p = 0.036), elbow flexion strength (p = 0.021), functional hand positioning (p = 0.008) and return to recreational activities (p = 0.043) after 6 weeks, no statistically significant differences existed in any outcome measure at the 1-year follow-up.
Our findings indicate that the non-operative management of humeral midshaft fractures can be expected to have similar functional outcomes and patient satisfaction at 1 year, despite an early benefit to operative treatment. If no radiological evidence of fracture healing exists in non-operatively treated patients during early follow-up, a switch to surgical treatment results in good functional outcomes and patient satisfaction.
尽管多年来一直提倡对闭合性肱骨干中段骨折进行非手术治疗，但手术干预的日益普及使得最佳治疗选择仍不明确。
比较成年患者创伤性闭合性肱骨干中段骨折手术与非手术治疗的效果。
开展了一项涉及20个中心的多中心前瞻性比较队列研究。AO分型为12 A2、A3和B2型骨折的患者采用功能性支具或逆行插入非扩髓肱骨髓内钉治疗。在受伤后6周、12周和52周进行随访测量。主要结局是伤后1年骨折愈合情况。次要结局包括Constant评分的子项目、患者总体满意度、并发症及成本效益参数。将未受伤肢体的功能作为对照参数。采用t检验、Fisher精确检验、Mann-Whitney U检验和调整后的方差分析进行意向性分析。
纳入47例患者。患者样本包括23名女性和24名男性，平均年龄52.7岁（范围17 - 86岁）。47例病例中，14例接受非手术治疗，33例接受手术治疗。1年时的随访率为81%。1年后，非手术组11例骨折（100%）愈合，手术组至少24例骨折（≥89%）愈合[1例骨不连患者（4%），2例患者（7%）无数据]。在伤后6周、12周和1年时，疼痛、肩和肘的活动范围（ROM）以及恢复工作情况方面无显著差异。尽管术后6周时接受手术治疗的患者在肩外展力量（p = 0.036）、肘屈曲力量（p = 0.021）、手部功能位（p = 0.008）和恢复娱乐活动（p = 0.043）方面表现明显更好，但在1年随访时任何结局指标均无统计学显著差异。
我们的研究结果表明，肱骨干中段骨折的非手术治疗在1年时可预期具有相似的功能结局和患者满意度，尽管手术治疗早期有一定优势。如果在早期随访期间非手术治疗患者没有骨折愈合的影像学证据，改为手术治疗可获得良好的功能结局和患者满意度。
