Garland D E, Jones R C, Kunkle R W
Department of Orthopaedic Surgery, University of Southern California, Los Angeles.
Clin Orthop Relat Res. 1988 Aug(233):110-5.
Fifty-three long bone upper extremity fractures in 46 patients with recent spinal cord injuries were reviewed with reference to the outcome of operative versus nonoperative treatment. Twenty-four fractures had surgery and 29 fractures were treated nonoperatively. Criteria used in assessing outcome included range of motion, time to union, total rehabilitation time, and orthopedic and medical complications. Humeral fractures had similar outcomes with either operative or nonoperative treatment. Radial nerve injury occurring with humeral fractures prolonged the rehabilitation time. All three combined radial and ulnar fracture treated surgically developed synostosis whereas two of the three nonoperatively treated fractures had other orthopedic complications. Nondisplaced radial fractures responded appropriately to closed treatment. Displaced radial fractures treated nonoperatively had a high incidence of malunion. All ulnar fractures were treated operatively, and all achieved acceptable range of motion and fracture healing at the time of discharge. Medical complications such as deep venous thromboses and decubitus ulcers occurred more frequently in the nonoperatively treated group (28%) than in the operatively treated group (4%). Standard guidelines for upper extremity fracture care apply to the patient with a spinal cord injury. However, operative stabilization may be associated with a decreased risk of medical complications in these patients.
回顾了46例近期脊髓损伤患者的53例上肢长骨骨折，比较了手术治疗与非手术治疗的结果。24例骨折接受了手术治疗，29例骨折接受了非手术治疗。评估结果的标准包括活动范围、愈合时间、总康复时间以及骨科和内科并发症。肱骨骨折手术治疗与非手术治疗的结果相似。肱骨骨折合并桡神经损伤会延长康复时间。所有3例接受手术治疗的桡尺骨联合骨折均发生了骨连接，而3例非手术治疗的骨折中有2例出现了其他骨科并发症。无移位的桡骨骨折采用闭合治疗效果良好。非手术治疗的移位桡骨骨折畸形愈合发生率高。所有尺骨骨折均接受手术治疗，出院时均获得了可接受的活动范围和骨折愈合。内科并发症如深静脉血栓形成和褥疮在非手术治疗组（28%）中比手术治疗组（4%）更常见。上肢骨折护理的标准指南适用于脊髓损伤患者。然而，手术固定可能会降低这些患者发生内科并发症的风险。
