Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland; University Medical Center Utrecht, Department of Traumatology, Heidelberglaan 100, 3584CX Utrecht, the Netherlands.
Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland.
Injury. 2019 Nov;50(11):1986-1991. doi: 10.1016/j.injury.2019.08.004. Epub 2019 Aug 11.
Minimal invasive plating (MIPO) techniques for humeral shaft fractures appear to have fewer complications and higher union rates compared to open reduction and internal fixation (ORIF). It is questionable if this also applies to simple humeral shaft fractures, as simple fractures are generally treated with absolute stability which cannot be obtained with MIPO. This raises the question whether biology or biomechanics is more important in fracture healing. This study was developed to investigate the biomechanical part of this equation. The aim of the study was to compare relative stability to absolute stability in simple humeral shaft fractures with regard to fracture healing METHODS: This was a retrospective study of all patients treated with plate fixation for AO/OTA type A1-B3 humeral shaft fractures. Patients were categorized into two groups: absolute stability and relative stability. Both groups were compared with regard to time to radiological union and full weight bearing RESULTS: Thirty patients were included in the relative-stability-group with either an AO/OTA type A (n = 18) or type B (n = 12) humeral shaft fracture and a mean age of 55 (SD 21) years. A total of 46 patients were included in the absolute-stability-group: 27 patients had a type A and 19 type B fracture. The mean age in this group was 45 (SD 19) years. Median follow-up was 12 months (IQR 8-13). Minimally invasive approach was used in 15 (50%) patients in the relative stability group. Time to radiological union was significantly shorter in the absolute-stability-group with a median of 14 (IQR 12-22) versus 25 (IQR17-36) weeks and HR 2.60 (CI 1.54-4.41)(p < 0.001). This difference remained significant after correction for type of approach (adjusted HR 3.53 CI 1.72-7.21) (p 0.001). There was no significant difference in time to full weight bearing. The addition of lag screws in the absolute stability group did not influence time to radiological healing or full weight bearing.
Absolute stability for simple humeral shaft fractures leads to a significantly shorter time to radiological union compared to relative stability. The addition of lag screws to gain interfragmentary compression does not reduce fracture healing time.
与切开复位内固定（ORIF）相比，微创接骨板技术（MIPO）治疗肱骨干骨折的并发症更少，愈合率更高。对于简单的肱骨干骨折，这种情况是否也适用还存在疑问，因为简单的骨折通常需要绝对稳定性，而 MIPO 无法获得这种稳定性。这就提出了一个问题，即骨折愈合中生物学和生物力学哪个更重要。本研究旨在探讨这个问题的生物力学部分。该研究的目的是比较简单肱骨干骨折中相对稳定性和绝对稳定性对骨折愈合的影响。
这是一项回顾性研究，纳入了所有接受钢板固定治疗的 AO/OTA 类型 A1-B3 肱骨干骨折患者。患者分为两组：绝对稳定性组和相对稳定性组。比较两组的影像学愈合时间和完全负重时间。
相对稳定性组共纳入 30 例患者，其中 AO/OTA 类型 A 骨折 18 例，类型 B 骨折 12 例，平均年龄 55 岁（标准差 21 岁）。绝对稳定性组共纳入 46 例患者，其中类型 A 骨折 27 例，类型 B 骨折 19 例，平均年龄 45 岁（标准差 19 岁）。中位随访时间为 12 个月（IQR 8-13）。微创入路在相对稳定性组的 15 例（50%）患者中使用。绝对稳定性组的影像学愈合时间明显更短，中位数为 14 周（IQR 12-22），而相对稳定性组为 25 周（IQR 17-36），HR 2.60（CI 1.54-4.41）（p<0.001）。校正入路类型后，这一差异仍然显著（调整 HR 3.53，CI 1.72-7.21）（p<0.001）。两组完全负重时间无显著差异。在绝对稳定性组中添加拉力螺钉并不会影响影像学愈合时间或完全负重时间。
与相对稳定性相比，简单肱骨干骨折的绝对稳定性可显著缩短影像学愈合时间。为了获得断端间加压而添加拉力螺钉不会减少骨折愈合时间。
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