Lin J
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei.
J Trauma. 1998 May;44(5):859-64. doi: 10.1097/00005373-199805000-00019.
To report the experience of a newly devised humeral locked nail in treating acute humeral shaft fractures and to compare its effectiveness with that of plate fixation.
Data were collected on 48 acute humeral shaft fractures in 48 consecutive patients treated with humeral locked nails and compared with retrospective data on 25 fractures in 25 other patients treated with dynamic compression plates. The operation time, amount of blood transfusion, time to union, complications, and functional recovery were recorded and compared. The average follow-up time was 20.5 months for the nail group and 33.3 months for the plate group. Student's t test and Fisher's Exact Test were used for statistical analyses.
Locked nailing had significantly shorter operation time and less blood transfusion than did plate fixation, 68 versus 93 minutes and 0 versus 102 mL, respectively. Eventual union was achieved among all in the nail group and among all but one in the plate group. Union rate and time to union were not significantly different. In the plate group, three fractures had complications: one with implant loosening and nonunion, one with deep infection, and one with postoperative radial nerve palsy; the nail group had no complications. The difference in complication rates was statistically significant. In the nail group, one varus malunion and one intraoperative comminution occurred, without adverse consequences. Functional recovery was essentially the same in both groups for uncomplicated fractures.
Humeral locked nailing offered a less invasive surgical technique and more favorable treatment results than did plate fixation. Correct nailing direction, precise surgical techniques, less bulky hardware, and stable transfixing screws are the keys to a successful treatment. Further prospective, randomized comparative study is warranted.
报告一种新设计的肱骨锁定髓内钉治疗急性肱骨干骨折的经验，并将其疗效与钢板固定进行比较。
收集48例连续使用肱骨锁定髓内钉治疗的急性肱骨干骨折患者的数据，并与25例使用动力加压钢板治疗的其他患者的回顾性数据进行比较。记录并比较手术时间、输血量、骨折愈合时间、并发症及功能恢复情况。髓内钉组平均随访时间为20.5个月，钢板组为33.3个月。采用Student's t检验和Fisher精确检验进行统计学分析。
锁定髓内钉固定术的手术时间明显短于钢板固定术，分别为68分钟和93分钟，输血量也明显少于钢板固定术，分别为0 mL和102 mL。髓内钉组所有患者最终均实现骨折愈合，钢板组除1例患者外其余患者也均实现骨折愈合。骨折愈合率和愈合时间差异无统计学意义。钢板组有3例骨折出现并发症：1例植入物松动不愈合，1例深部感染，1例术后桡神经麻痹；髓内钉组无并发症。并发症发生率差异有统计学意义。髓内钉组发生1例内翻畸形愈合和1例术中骨折粉碎，但无不良后果。对于无并发症的骨折，两组功能恢复基本相同。
与钢板固定相比，肱骨锁定髓内钉固定术是一种侵入性较小的手术技术，治疗效果更佳。正确的进钉方向、精确的手术技术、体积较小的内固定物以及稳定的贯穿螺钉是治疗成功的关键。有必要进行进一步的前瞻性随机对照研究。
