经皮微创接骨板技术与髓内钉固定治疗肱骨干骨折的疗效比较

Comparison of minimally invasive plating osteosynthesis and intramedullary nail fixation in treatment of humeral shaft fractures

目的比较经皮微创接骨板（MIPO）技术与髓内钉（IMN）固定技术治疗肱骨干骨折的临床效果。方法回顾性分析2007年3月至2009年1月收治的52例肱骨干中下段骨折患者临床资料，分别采用闭合复位MIPO内固定（MIPO组）与顺行IMN固定（IMN组）。MIPO组27例，男15例，女12例；年龄18．65岁，平均36．7岁；IMN组25例，男16例，女9例；年龄25—63岁，平均39．4岁。记录两组患者手术时间、术中出血量、骨折愈合时间、并发症、肘关节Mayo评分及肩关节Constant评分。结果所有患者获16～36个月（平均17．8个月）随访。两组患者在手术时间、术中出血量、住院天数、骨折愈合时间及肘关节Mayo评分比较差异均无统计学意义（P〉0．05）。MIPO组术后无骨不连与桡神经麻痹等并发症发生；IMN组术后4例发生骨不连，2例出现桡神经麻痹，1例出现内翻畸形，但功能良好。MIPO组患者骨不连发生率低于IMN组，肩关节Constant评分高于IMN组，差异均有统计学意义（P〈0．05）。结论MIPO微创内固定技术治疗肱骨干骨折具有创伤小、术中出血量少、骨性愈合快、肩肘功能恢复好等优点，同时能减少医源性桡神经损伤的风险。

Objective To compare clinical outcomes of minimally invasive plating osteosynthesis （MIPO） and intramedullary nail stabilization in treatment of acute humeral shaft fractures. Methods From March 2007 to January 2009, 52 patients were treated in our department for acute fractures of middle and lower humeral shaft. Twenty-seven were treated with MIPO technique （group A） and 25 with intramedullary nail （group B） . In group A, there were 15 men and 12 women, aged from 18 to 65 years （average, 36.7 years）; in group B, there were 16 men and 9 women, aged from 25 to 63 years （average, 39.4 years）. Operation time, amount of blood transfusion, hospital stay, time for union, complications, Mayo scores of the elbow and Constant scores of the shoulder were recorded in both groups and compared statisti- cally. Results The mean follow-up time was t7.8 months （range, 16 to 36 months） . There were no significant differences between the 2 groups in operation time, amount of blood transfusion, hospital stay, time for union, and Mayo scores of the elbow （ P 〉 0.05） . There was no case of postoperative iatrogenic radial nerve palsy or non-union in group A, but there were 4 cases of non-union, 2 cases of iatrogenic radial nerve palsy and one case of varus malunion in group B. Compared with group B, group A showed significant ad- vantages in rate of postoperative non-union and Constant scores of the shoulder functional recovery （ P 〈 0. 05） . Conclusion In treatment of humeral shaft fractures, MIPO technique has advantages of less operative invasion, quick bone union, satisfactory shoulder functional recovery and low risk of postoperative palsy of the iatrozenic radial nerve.