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肱骨骨干骨折采用带锁髓内钉与锁定加压钢板治疗的对比

Management of Humeral Shaft Fractures With Intramedullary Interlocking Nail Versus Locking Compression Plate.

作者信息

Fan Yu, Li Yue-Wang, Zhang Hong-Bo, Liu Jian-Fei, Han Xiang-Min, Chang Xiao, Weng Xi-Sheng, Lin Jin, Zhang Bao-Zhong

出版信息

Orthopedics. 2015 Sep;38(9):e825-9. doi: 10.3928/01477447-20150902-62.

Abstract

Surgical fixation of humeral shaft fractures generally involves plating or nailing. It is unclear whether one method is more effective than the other. The aim of this study was to compare the results of the intramedullary nail and locking compression plate for the treatment of humeral shaft fractures. A total of 60 patients with humeral shaft fractures were randomized to undergo surgery with an intramedullary interlocking nail (n=30) or locking compression plate (n=30). The outcome was assessed in terms of intraoperative blood loss, operative time, hospital stay, union time, union rate, functional outcome, and incidence of complications. Functional outcome was assessed using the Constant score and the American Shoulder and Elbow Surgeons (ASES) score. Intraoperative blood loss, operative time, and hospital stay in group A (intramedullary interlocking nail) were significantly lower than those in group B (locking compression plate). No statistically significant difference was found regarding the union rate, mean Constant score, and mean ASES score between the groups. The average union time was found to be significantly lower for the intramedullary interlocking nail compared with the locking compression plate. The incidence of complications such as radial nerve palsy was found to be higher with the locking compression plate compared with the intramedullary interlocking nail. The intramedullary interlocking nail can be considered a better surgical option for the management of humeral shaft fractures because it offers decreased intraoperative blood loss; shorter operative times, hospital stays, and union times; and a lower incidence of serious complications such as radial nerve palsy.

摘要

肱骨干骨折的手术固定通常包括钢板固定或髓内钉固定。目前尚不清楚哪种方法更有效。本研究的目的是比较髓内钉和锁定加压钢板治疗肱骨干骨折的效果。共有60例肱骨干骨折患者被随机分为两组,分别接受髓内交锁钉手术(n = 30)或锁定加压钢板手术(n = 30)。通过术中失血量、手术时间、住院时间、骨折愈合时间、愈合率、功能结果和并发症发生率来评估治疗效果。使用Constant评分和美国肩肘外科医师(ASES)评分评估功能结果。A组(髓内交锁钉)的术中失血量、手术时间和住院时间显著低于B组(锁定加压钢板)。两组之间在骨折愈合率、平均Constant评分和平均ASES评分方面未发现统计学上的显著差异。结果发现,髓内交锁钉的平均骨折愈合时间明显低于锁定加压钢板。与髓内交锁钉相比,锁定加压钢板导致的桡神经麻痹等并发症发生率更高。髓内交锁钉可被认为是治疗肱骨干骨折更好的手术选择,因为它能减少术中失血量,缩短手术时间、住院时间和骨折愈合时间,并降低桡神经麻痹等严重并发症的发生率。

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