两种肱骨内固定方法的实验与临床应用对比研究

Experimental and clinical study of two internal fixation methods for humerus fracture

目的通过矩形髓内钉和加压钢板两种不同内固定物治疗肱骨干骨折的生物力学分析,探讨有利于肱骨干骨折后的骨修复的内固定方法。方法以成人尸体湿骨制备骨折模型,随机用矩形髓内钉和加压钢板两种方法固定后进行四点弯曲试验、扭转试验和拉伸试验。分两组用矩形髓内钉和加压钢板治疗肱骨干骨折92例和78例。将实验数据和临床疗效进行分析。结果测试数据经统计学检验,矩形髓内钉组的四点弯曲试验和扭转试验均优于钢板组(P<0·01),结果有显著差异,而拉伸试验中矩形髓内钉和加压钢板组无显著差异(P>0·05)。矩形髓内钉固定组病人骨折平均愈合期为13周,功能优良率91·3%。加压钢板固定组骨折平均愈合期为18·2周,功能优良率为80·8%。结论在肱骨干骨折的治疗中,肱骨矩形钉内固定较加压钢板内固定更适合骨折愈合所需的生物力学环境,且临床效果较后者优。

Objective To search for a better internal fixation method in the treatment of humeral shaft fracture by comparing biomechanics and clinical results of fracture fixation with rectangle intramedullary nail and compressed plate. Methods ①Fracture models were produced in 24 wet humeral bones of adult cadavers. The models were randomly divided into two groups fixed with rectangle intramedullary nail and compressed plate respectively. Four-point bending test, twisting test and pull test were performed on the facture models after fixation and another 12 intact wet humeral bone specimens. ②The humeral shaft fracture patients were treated with rectangle intramedullary nail (92 cases) and compressed plate (78 cases). The experimental and clinical data were analyzed and compared. Results The statistical results of bending test and twisting test revealed that the rectangle intramedullary nail was better than the compressed plate for the fixation of humeral shaft fracture (P<0.01), but in pull test, two fixation methods showed no significant difference (P>0.05). Fracture healing time was 13 weeks in average and the rate of excellent and better function was 91.3% in the rectangle intramedullary nail fixation group, while both were 18.2 weeks and 80.8% respectively in the compressed plate fixation group. Conclusion The rectangle intramedullary nail fixation is more suitable than the compressed plate fixation for the treatment of humeral shaft fracture.