Hughston Clinic, Jacksonville, Florida.
University of Louisville, Louisville, Kentucky.
J Surg Orthop Adv. 2021 Summer;30(2):67-72.
The purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score, visual analogue score (VAS) or elbow range of motion (ROM) at 6 months. However, 11% of the FB group developed nonunion. Complications in the ORIF group included a 2% infection and nonunion rate and 13% iatrogenic radial nerve dysfunction (RND). ORIF can be expected to result in higher union rates with the inherent risks of infection and RND. Finally, at 6 months, both groups demonstrated higher DASH scores than population norms, indicating a lack of full recovery. (Journal of Surgical Orthopaedic Advances 30(2):067-072, 2021).
目的是比较单独的肱骨骨干骨折的钢板螺钉固定（切开复位内固定 [ORIF]）和功能支具（FB）固定的治疗和患者为基础的结果。我们在 12 个中心进行了 ORIF 与 FB 的前瞻性试验。外科医生向患者介绍了治疗选择，并做出了以患者为中心的决策。我们共招募了 179 名患者，其中对 102 名（39 名女性；63 名男性）患者进行了 6 个月的数据分析。45 例采用 ORIF 治疗，57 例采用 FB 治疗。我们发现，6 个月时，手臂、肩部和手部残疾（DASH）评分、视觉模拟评分（VAS）或肘部活动范围（ROM）无差异。然而，FB 组有 11%发生了骨不连。ORIF 组的并发症包括 2%的感染和不愈合率，以及 13%的医源性桡神经功能障碍（RND）。ORIF 可预期更高的愈合率，但存在感染和 RND 的固有风险。最后，6 个月时，两组的 DASH 评分均高于人群正常值，表明未完全恢复。（《手术矫形进展杂志》30（2）：067-072，2021）。
