Lian Kejian, Wang Lei, Lin Dasheng, Chen Zhiwen
Orthopedics. 2013 Aug;36(8):e1025-32. doi: 10.3928/01477447-20130724-18.
Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Intraoperative measurements included blood loss and operative time. Clinical outcome measurements included fracture healing, radial nerve recovery, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Functional outcome was satisfactory in both groups. Mean American Shoulder and Elbow Surgeons score and Mayo score were both better for the minimally invasive plating osteosynthesis group than for the IMN group (98.2 vs 97.6, respectively, and 93.5 vs 94.1, respectively; P<.001). Operative time was shorter and less intraoperative blood loss occurred in the minimally invasive plating osteosynthesis group than in the IMN group. Average time to union was similar in both groups. Primary union was achieved in 23 of 24 patients in the minimally invasive plating osteosynthesis group and in 22 of 23 in the IMN group. Minimally invasive plating osteosynthesis may have outcomes comparable with IMN for the management of mid-distal third humeral shaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures.
肱骨干中下段三分之一骨折可通过微创钢板接骨术和髓内钉固定术（IMN）进行有效治疗。然而，这两种治疗方法尚未得到充分比较。47例（47处骨折）肱骨干中下段三分之一骨折患者被随机分配接受微创钢板接骨术（n = 24）或髓内钉固定术（n = 23）。两组在骨折类型、骨折部位、年龄和合并损伤方面相似。术中测量包括失血量和手术时间。临床结果测量包括骨折愈合、桡神经恢复以及肘部和肩部不适。影像学测量包括骨折对线、愈合时间、延迟愈合和不愈合。两组的功能结果均令人满意。微创钢板接骨术组的平均美国肩肘外科医师评分和梅奥评分均高于髓内钉固定术组（分别为98.2对97.6，以及93.5对94.1；P <.001）。微创钢板接骨术组的手术时间较短，术中失血量也少于髓内钉固定术组。两组的平均愈合时间相似。微创钢板接骨术组24例患者中有23例实现一期愈合，髓内钉固定术组23例中有22例实现一期愈合。对于肱骨干中下段三分之一骨折的治疗，微创钢板接骨术的效果可能与髓内钉固定术相当。与用于简单骨折的髓内钉固定术相比，微创钢板接骨术更适合复杂骨折，尤其是对于桡神经保护和相邻关节的活动恢复。
