肱骨干骨折282例临床报告

Clinical report of 282 patients with humeral shaft fracture

目的:观察肱骨干骨折不同的治疗方法,探讨肱骨干骨折非手术及简单手术治疗的可行性。方法:282例285侧肱骨干骨折,男182例,女100例;年龄1～95岁,平均45岁;其中1～18岁70例,19～60岁181例,61岁以上31例。左133侧,右152侧。合并桡神经损伤14例,正中神经损伤2例,肱动脉损伤3例。闭合伤216侧,开放性损伤69侧。就诊时间伤后1h～20d,平均4d。按骨折AO分型:A型124侧,B型122侧,C型39侧。采用闭合复位改制夹板固定186侧,钢板螺钉固定43侧,双克氏针固定25侧,带锁髓内针固定31侧。结果:所有患者均获得随访,时间12～48个月,平均30个月。按照骨折愈合评定标准及肩肘关节功能评价标准,改制夹板固定组:愈合183侧,不愈合3侧;功能恢复优115侧,良69侧,差2侧。钢板螺钉固定组:愈合41侧,不愈合2侧;功能恢复优25侧,良14侧,差4侧。双克氏针固定组:愈合24侧,不愈合1侧;功能恢复优20侧,良4侧,差1侧。带锁髓内针固定组:愈合30侧,不愈合1侧;优20侧,良8侧,差3侧。结论:不复杂的肱骨干骨折采用闭合复位改制夹板固定治疗效果满意。

Objective：To evaluate the effect of different device for humeral shaft fracture and explore the feasibility of therapeutic method with not-operation and simple operation.Methods：Two hundred and eighty-two patients（285 sites） with humeral shaft fracture were treated with different ways.One hundred and thirty-three cases on the left and 152 on the right.There were 182 males and 100 females with mean age of 45 years（range 1-95 years）.The mean duration from injury to operation was 4 days（1 hour-20 days）.Among the all cases,216 were close injury and 69 open injury.Including radial nerve injury 13 cases,median nerve injury 2 cases,brachial artery injury 3 cases.According to the AO classification：type A 124 cases,type B 122 cases and type C 39 cases.Treatment including ①manipulative reduction and modified splintage（186 cases）,②dynamic compression plate fixation（43 cases）,③two Kirschner wires fixation（25 cases）,④interlocking nail fixation（31 cases）.Results：All the patients were followed up from 12 to 48 months with an average of 30 months.Evaluation based on the standard of bone healing and the function of shoulder and elbow joint,①manipulative reduction and modified fixation：bone union were in 183 cases,nonunion 3 cases;115 cases obtained excellent results,69 good,2 poor.②dynamic compression plate fixation：bone union 41 cases,nonunion 2 cases;25 cases obtained excellent results,14 good,4 poor.③Kirschner wires fixation：bone union in 24 cases,nonunion 1 case;20 cases obtained excellent results,4 good,1 poor.④interlocking nail fixation：bone union in 30 cases,nonunion 1 case;20 cases obtained excellent results,8 good,3 poor.Conclusion：The therapeutic effect of manipulative reduction and modified splintage is satisfactory to the non-complicated humeral shaft fracture.