髓内髓外固定治疗肱骨干骨折的疗效

Comparison of intramedullary nail or plate in the management of diaphyseal fractures of the humerus

目的评估髓内髓外固定治疗肱骨干骨折的肩关节功能和术后并发症。方法对35例肱骨干骨折患者分别应用闭合复位髓内钉技术(髓内钉组,16例)和切开复位钢板螺钉固定(钢板组,19例)治疗。比较两组术后关节功能和并发症。结果患者均获随访,时间24～40(32.7±5)个月。骨折愈合时间8～32(11.9±4)周。出血量:髓内钉组40～80(60±20)ml,钢板组140～240(200±22)ml。钢板组发生伤口浅表感染1例;髓内钉组发生桡神经损伤2例,骨不连1例,再次骨折1例。肩关节功能:术后2～4周钢板组明显优于髓内钉组(P<0.05),术后6周两组间差异无统计学意义(P>0.05)。结论闭合复位髓内钉治疗肱骨干骨折创伤小、出血少,但容易造成肩袖和关节囊的损伤,近期肩关节活动不如切开复位钢板螺钉固定。

Objective To evaluate the result of intramedullary nail or plate for the management of diaphyseal fractures of the humerus.Methods 35 patients with diaphyseal fractures of the humerus underwent operating.There were 16 nails and 19 plates.The complications after operations and the function of the shoulder were compared.Results After 24-40（32.7±5）months follow-up,the union time was 8-32（11.9±4）weeks,and blood loss was 40-80（60±20） ml in intramedullary nail group,and 140-240（200±22）ml in plate group.There was one patient with superficial infection in the plate group,and there were one patient with nonunion,one refracture,and two radial nerve impairment.The shoulder function outcome in the plate group is better in the first 4 weeks（P〈0.05）,and another 2 weeks later there was no difference between the two groups（P〉0.05）.Conclusions It is less invasive in the intramedullary group,but it is easy to impair the shoulder joint and cuff.The shoulder function is better in the plate group in the early period after operation.