Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Bone Joint Surg Am. 2023 Jul 19;105(14):1101-1111. doi: 10.2106/JBJS.22.00647. Epub 2023 May 23.
Plate osteosynthesis (referred to throughout as plating) and intramedullary nailing (referred to throughout as nailing) are the most common operative strategies for humeral shaft fractures. However, it is undecided which treatment is more effective. This study aimed to compare functional and clinical outcomes of these treatment strategies. We hypothesized that plating would result in an earlier recovery of shoulder function and fewer complications.
From October 23, 2012, to October 3, 2018, adults with a humeral shaft fracture, OTA/AO type 12A or 12B, were enrolled in a multicenter, prospective cohort study. Patients were treated with plating or nailing. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant-Murley score, ranges of motion of the shoulder and elbow, radiographic healing, and complications until 1 year. Repeated-measure analysis was done with correction for age, sex, and fracture type.
Of the 245 included patients, 76 were treated with plating and 169 were treated with nailing. Patients in the plating group were younger, with a median age of 43 years compared with 57 years for the nailing group (p < 0.001). The mean DASH score after plating improved faster over time, but did not differ significantly from the score after nailing at 12 months (11.7 points [95% confidence interval (CI), 7.6 to 15.7 points]) for plating and 11.2 points [95% CI, 8.3 to 14.0 points] for nailing). The Constant-Murley score and shoulder abduction, flexion, external rotation, and internal rotation displayed a significant treatment effect (p treatment ≤ 0.001), in favor of plating. The plating group had 2 implant-related complications, whereas the nailing group had 24, including 13 nail protrusions and 8 screw protrusions. Plating resulted in more postoperative temporary radial nerve palsy (8 patients [10.5%] compared with 1 patient [0.6%]; p < 0.001) and a trend toward fewer nonunions (3 patients [5.7%] compared with 16 patients [11.9%]; p = 0.285) than nailing.
Plating of a humeral shaft fracture in adults results in faster recovery, especially of shoulder function. Plating was associated with more temporary nerve palsies, but fewer implant-related complications and surgical reinterventions, than nailing. Despite heterogeneity in implants and surgical approach, plating seems to be the preferred treatment option for these fractures.
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
钢板内固定（简称钢板）和髓内钉内固定（简称髓内钉）是治疗肱骨干骨折最常用的手术方法。然而，哪种治疗方法更有效仍存在争议。本研究旨在比较这两种治疗策略的功能和临床结果。我们假设钢板内固定将更早地恢复肩部功能并减少并发症。
从 2012 年 10 月 23 日至 2018 年 10 月 3 日，纳入肱骨干骨折、OTA/AO 12A 或 12B 型的成年患者，进行多中心前瞻性队列研究。患者接受钢板或髓内钉治疗。评估指标包括上肢残疾量表（DASH）评分、Constant-Murley 评分、肩关节和肘关节活动范围、影像学愈合情况以及 1 年内的并发症。采用重复测量分析，校正年龄、性别和骨折类型。
在纳入的 245 例患者中，76 例接受钢板内固定治疗，169 例接受髓内钉内固定治疗。钢板内固定组患者年龄较小，中位年龄为 43 岁，而髓内钉内固定组为 57 岁（p<0.001）。钢板内固定组的 DASH 评分在随访期间恢复更快，但在 12 个月时与髓内钉内固定组的评分无显著差异（钢板内固定组为 11.7 分[95%置信区间（CI）：7.6 至 15.7 分]，髓内钉内固定组为 11.2 分[95%CI：8.3 至 14.0 分]）。Constant-Murley 评分和肩关节外展、前屈、外旋和内旋均显示出显著的治疗效果（p<0.001），有利于钢板内固定。钢板内固定组有 2 例与植入物相关的并发症，而髓内钉内固定组有 24 例，包括 13 例钉突出和 8 例螺钉突出。钢板内固定组术后暂时性桡神经麻痹的发生率更高（8 例[10.5%]与 1 例[0.6%]；p<0.001），且非愈合的发生率更低（3 例[5.7%]与 16 例[11.9%]；p=0.285）。
成人肱骨干骨折钢板内固定可更快恢复，尤其是肩部功能。钢板内固定与暂时性神经麻痹发生率较高有关，但与植入物相关并发症和再次手术干预的发生率较低有关。尽管植入物和手术方法存在异质性，但钢板似乎是这些骨折的首选治疗方法。
治疗性 II 级。详见《作者须知》，以获取完整的证据等级描述。
