桥接组合内固定系统与锁定钉板系统治疗闭合性肱骨干骨折的疗效比较

Bridge combined internal fixation system and locking plate system in treatment of closed humeral shaft fracture

目的比较桥接组合式内固定系统与锁定钉板系统治疗肱骨干骨折的临床疗效。方法纳入2017年8月至2020年8月闭合性肱骨干骨折患者45例,采用小切口有限切开复位及桥接组合式内固定系统固定19例(桥接组),男13例、女6例,年龄(38.3±11.9)岁(范围21~72岁);采用小切口有限切开复位及锁定钉板系统固定26例(锁定钉板组),男20例、女6例,年龄(41.2±14.7)岁(范围20~79岁)。术后定期随访,每4周记录骨折愈合情况,采用加州大学洛杉矶分校(University of California at Los Angeles,UCLA)肩关节功能评分评定肩关节功能、梅奥肘关节功能评分系统(Mayo elbow performance score,MEPS)评定肘关节功能。结果45例患者随访时间为(14.2±4.7)个月(范围10~32个月),手术切口均一期愈合。桥接组手术时间为(68.1±12.5)min,大于锁定钉板组的(56.3±11.6)min(t=3.32,P=0.002);桥接组与锁定钉板组术中出血量分别为(112.6±20.2)ml、(104.2±14.1)ml,术后引流量分别为(68.4±16.2)ml、(73.1±14.9)ml,住院时间分别为(9.7±2.3)d、(9.4±1.9)d,组间差异均无统计学意义(t=1.65,P=0.107;t=1.00,P=0.323;t=0.57,P=0.573)。桥接组1例患者骨折不愈合,其余患者骨折愈合时间为(15.3±4.3)周,锁定钉板组为(15.9±3.9)周,两组差异无统计学意义(t=0.47,P=0.638)。术后4周,桥接组UCLA肩关节评分为(18.1±3.9)分、MEPS为(55.4±6.8)分,均低于锁定钉板组(P<0.05);术后8周,桥接组UCLA肩关节评分为(26.2±4.3)分、MEPS为(70.9±6.5)分,均低于锁定钉板组(P<0.05);术后12周,桥接组UCLA肩关节评分为(33.6±1.0)分、MEPS为(91.0±3.7)分,优良率达100%,与锁定钉板组的差异均无统计学意义(P>0.05)。结论应用桥接组合式内固定系统治疗肱骨干骨折可根据骨折形态进行个性化多维固定,至术后12周可达到与锁定钉板固定相似的临床疗效;但应用桥接组合式内固定系统的手术时间略长,并可能增加骨折不愈合的风险。

Objective To compare the clinical effects of bridge combined internal fixation system and locking plate system in treating closed humeral shaft fracture.Methods From August 2017 to August 2020,there were 45 patients with closed humeral shaft fracture treated with surgery.Bridge combined internal fixation system were performed in 19 patients(bridge combined group,aged 38.3±11.9,range 21-72 years),including 13 males and 6 females.Further,there were 26 patients underwent locking plate system(locking plate group,aged 41.2±14.7,range 20-79 years),including 20 males and 6 females.The operation was performed by minimal invasive percutaneous osteosynthesis with fixators.The patients were followed up every 4 weeks.The fracture healing condition was recorded.Shoulder function was assessed according to University of California at Los Angeles(UCLA)shoulder rating scale and elbow function was assessed according to Mayo elbow performance score(MEPS).Results The follow-up duration of all patients were 14.2±4.7(range 10-32)months.All wound were healed completely.The operation duration in bridge combined group(68.1±12.5 min)was longer than that in locking plate group(56.3±11.6 min)(t=3.32,P=0.002).The blood loss of bridge combined group and locking plate group were 112.6±20.2 ml and 104.2±14.1 ml,respectively(t=1.65,P=0.107).The volume of drainage of bridge combined group was 68.4±16.2 ml and that of locking plate group was 73.1±14.9 ml(t=1.00,P=0.323).The hospitalization time of bridge combined group was 9.7±2.3 d and the locking plate group was 9.4±1.9 d(t=0.57,P=0.573).All above parameters had no statistical significance between the two groups.Fracture nonunion occurred in 1 of 19 patients in bridge combined group.The fracture healing time was 15.3±4.3 weeks in another 18 cases,while that of locking plate group was 15.9±3.9 weeks(t=0.47,P=0.638).At 4-weeks postoperative follow-up,the UCLA shoulder score(18.1±3.9)and the MEPS(55.4±6.8)of bridge combined group were lower than those of locking plate group(P<0.05).At 8-weeks postoperative follow-up,the shoulder score(26.2±4.3)and the MEPS(70.9±6.5)of bridge combined group were lower than those of locking plate group(P<0.05).At 12-weeks postoperative follow-up,the UCLA shoulder score(33.6±1.0)and the MEPS(91.0±3.7)of bridge combined group had no statistical difference with those of locking plate group(P>0.05).Conclusion The bridge combined internal fixation system could provide personalized and multidimensional fixation according to the fracture type.The clinical effects of bridge combined internal fixation system on humeral shaft fracture are similar to the locking plate system at 12 weeks postoperatively.However,the operation duration of bridge combined system is longer and with increased the risk of nonunion.