一期清创内固定与延迟分期手术治疗Gustilo Ⅰ、Ⅱ型肱骨远端骨折的比较研究

Emergency versus delayed definitive management of open distal humeral fractures of Gustilo types Ⅰ & Ⅱ

目的比较一期清创内固定与延迟分期手术治疗Gustilo Ⅰ、Ⅱ型肱骨远端骨折的疗效。方法回顾性分析2013年1月至2017年6月北京积水潭医院创伤骨科收治的24例Gustilo Ⅰ、Ⅱ型肱骨远端骨折患者资料。根据治疗方式不同分为两组:一期清创内固定组8例,急诊即刻行清创后内固定治疗;延迟分期手术组16例,在急诊清创后进行缝合包扎,待软组织条件好转后再行二期切开复位内固定治疗。比较两组患者术后末次随访时的屈伸活动度、旋转活动度、疼痛视觉模拟(VAS)评分、Mayo肘关节功能(MEPS)评分、QuickDASH评分、并发症发生率及二次手术率等。结果所有患者均获1年以上随访,一期清创内固定组与延迟分期手术组平均随访时间分别为40.5个月和30.9个月。两组患者在活动度、VAS评分[0(0,1.0)分和0(0,2.0)分]、MEPS评分[95.00(85.00,100)分和90.00(80.00,98.75)分]、QuickDASH评分[7.96(2.84,14.77)分和3.41(0,13.64)分]比较差异均无统计学意义(P>0.05),并发症发生率及二次手术率相近。结论一期清创内固定与延迟分期手术治疗Gustilo Ⅰ、Ⅱ型肱骨远端骨折均可取得满意的疗效,应根据术者经验、患者局部和整体情况综合判断,选择合理的手术方式。

Objective To compare the clinical outcomes between emergency and delayed definitive management of open distal humeral fractures of Gustilo types of Ⅰ & Ⅱ.Methods A retrospective study was conducted of the 24 patients who had been treated at Department of Orthopaedic Trauma,Beiiing Jishuitan Hospital from January 2013 to June 2017 for open distal humeral fractures of Gustilo types Ⅰ & Ⅱ.Of them, 8received irrigation,debridement and definitive open reduction and internal fixation in the emergency operation room;the other 16received only irrigation,debridement and wound suture for the emergency management and their definitive open reduction and intemaI fixation was delayed until recovery of their soft tissues. The 2 groups were compared in terms of elbow range of motion,visual analogue scale (VAS),Mayo Elbow Performance Score (MEPS),Quick Disabilities of the Arm,Shoulder and Hand,(QuickDASH),complications and reoperations at the last follow-up.Results All the patients were followed up for more than one year;the average follow-up time was 40.5 months for the emergency treatment group and 30.9 months for the delayed treatment group.There were no significant differences between the 2 groups regarding elbow range of motion,VAS [0(0,1.0)versus 0(0,2.0)],MEPS [95.00(85.00,100)versus 90.00(80.00, 98.75)],or QuickDASH [7.96(2.84,14.77)versus 3.41(0,13.64)](P >0.05).The 2groups also had similar rates of complications and reoperations.Conclusions Both emergency and staged definitive management can lead to satisfactory clinical outcomes for open distal humeral fractures of Gustilo types of Ⅰ & Ⅱ.A proper treatment method should depend on the experience of surgeons concerned and the local and general conditions of the patient.