摘要
背景：肱骨干下1／3骨折有手术和非手术两种治疗方法，两种治疗方法的拥护者各持己见，但鲜有相互比较的资料。我们对这两种治疗方法进行了回顾性比较。
方法：从创伤骨科资料库确定的连续性51例肱骨干下1／3关节外闭合性骨折患者。其中，40例患者随访时间至少6个月或至骨折愈合，11例患者因随访不全被排除。19例患者行钢板螺钉固定，21例应用功能支具治疗。
结果：手术治疗组，1例固定失效，1例术后感染，1例因为术前桡神经麻痹没有恢复，而行肌腱转移术。3例患者术后出现桡神经麻痹，其中1例在术后3个月最后评估时仍然没有恢复。手术治疗的所有骨折均愈合，成角畸形均〈10°，1例患者肩、肘关节功能受限20°；非手术组，2例患者因主诊医生考虑骨折对线及桡神经麻痹，改行钢板固定。仅有1例患者在各平面均有〉30°的成角。2例患者在治疗期间发生皮肤破溃，经三角巾悬吊完成治疗。2例患者肘或肩关节功能受限≥20°。
结论：肱骨干下1／3关节外骨折，手术治疗可获得理想的对位，能更快的恢复功能，但是存在医原性神经损伤、感染及需要再次手术的风险。功能支具可能引起皮肤的问题和不同程度的成角畸形，但常可获得优良的活动范围与功能。
可信水平：治疗性研究，Ⅲ级，进一步可信度参见作者介绍。
Background： There are strong advocates for both operative and nonoperative treatment of distal-third diaphyseal fractures of the humerus, but there are few comparative data. We performed a retrospective comparison of these two treatment methods.
Methods： Fifty-one consecutive patients with a closed, extra-articular fracture of the distal one-third of the humeral diaphysis were identified from an orthopaedic trauma database. Forty patients were followed for at least six months or until healing of the fracture. Eleven patients were excluded because of inadequate follow-up. Nineteen patients had been managed with plate-and-screw fixation, and twenty-one had been managed with functional bracing.
Results： Among the operatively treated patients, one had loss of fixation, one had a postoperative infection, and one required tendon transfers for the treatment of a preoperative radial nerve palsy that did not resolve. Three new postoperative radial nerve palsies developed, and one had not resolved when the patient was last evaluated, three months after surgery. All operatively treated fractures healed with 〈10° of angular deformity, and one patient lost 20° of shoulder or elbow motion. Among the nonoperatively treated fractures, two were converted to plate fixation because of the treating surgeons＇ concern regarding alignment and radial nerve palsy. Only one patient had 〉30° of malalignmerit in any plane. Two patients had development of skin breakdown during treatment and completed treatment in a sling. Two patients lost ≥20° of elbow or shoulder motion.
Conclusions： For extra-articular distal-third diaphyseal humeral fractures, operative treatment achieves more predictable alignment and potentially quicker return of function but risks iatrogenic nerve injury and infection and the need for reoperation. Functional bracing can be associated with skin problems and varying degrees of angular deformity, but function and range of motion are usually excellent.
Level of Evidence： Therapeutic Level Ⅲ. See Instructions to Authors for a complete description of levels of evidence
