闭合复位弹性髓内钉内固定与切开复位锁定加压钢板内固定治疗青少年肱骨干骨折的疗效比较

A clinical comparison of closed reduction and elastic stable intramedullary nail internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents

目的：比较闭合复位弹性髓内钉内固定与切开复位锁定加压钢板内固定治疗青少年肱骨干骨折的临床疗效和安全性。方法：回顾性分析采用闭合复位弹性髓内钉内固定和切开复位锁定加压钢板内固定治疗的57例青少年肱骨干骨折患者的病例资料,男36例,女21例;年龄14-18岁,中位数16岁。均为闭合性损伤。受伤至手术时间2-5 d,中位数3 d10闭合复位弹性髓内钉内固定28例,切开复位锁定加压钢板内固定29例。记录2组患者手术时间、术中出血量、住院时间,随访观察术后骨折愈合、患肢功能恢复及并发症发生情况,并进行比较。结果：57例患者均顺利完成手术,弹性髓内钉组手术时间较锁定加压钢板组短,且术中出血量少[（32.1±5.6）min,（103.8±25.2）min,t=30.770,P=0.000;（13.9±3.9）m L,（171.0±58.2）m L,t=14.246,P=0.000];但2组患者住院时间比较,组间差异无统计学意义[（8.8±1.10）d,（9.1±1.3）d,t=1.006,P=0.319]。57例患者均获随访,随访时间12-36个月,中位数25个月;骨折均愈合,弹性髓内钉组骨折愈合时间较锁定加压钢板组长[（10.7±2.2）周,（9.3±1.9）周;t=2.440,P=0.018]。采用Constant评分标准评价肩关节功能,弹性髓内钉组优26例、良1例、可1例,锁定加压钢板组优26例、良2例、可1例,2组间差异无统计学意义（Z=-0.407,P=0.684）。采用Mayo肘关节功能评分标准评价肘关节功能,弹性髓内钉组优25例、良2例、可1例,锁定加压钢板组优25例、良2例、可2例,2组间差异无统计学意义（Z=-0.378,P=0.705）。2组患者均无感染、内固定断裂、骨折畸形愈合等并发症发生。弹性髓内钉组并发骨折延迟愈合1例,未行特殊处理,术后16周骨折愈合。锁定加压钢板组术后并发桡神经损伤4例,经积极功能锻炼后,患肢功能恢复;拆除内固定后并发再骨折1例,再次行切开复位锁定加压钢板固定后骨折愈合。2组患者并发症发生率比较,组间差异无统计学意义（χ2=0.802,P=0.371）。结论：采用闭合复位弹性髓内钉内固定和切开复位锁定加压钢板内固定治疗青少年肱骨干骨折,均有利于患肢功能的恢复,疗效相当,安全可靠;前者较后者手术时间短、损伤小,但骨折愈合时间长。

Objective：To compare the clinical curative effect and safety of closed reduction and elastic stable intramedullary nail （ESIN） internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents. Methods ： The medical records of 57 adolescent patients with closed fracture of humeral shaft were analyzed retrospectively. The patients consisted of 36 males and 2l females,ranged in age from 14 to 18 years（ Median = 16 yrs） ,and ranged in disease course from 2 to 5 days（ Median =3 days）. Closed reduction and ESIN internal fixation were performed in 28 patients（ ESIN group）and open reduction and locking compression plate internal fixation were performed in 29 patients （locking compression plate group）. Then the operative time, blood loss, hospital stay, fracture healing,limbs functional recovery and complications were recorded and compared between the 2 groups. Results ： The surgery were performed successfully on 57 patients. ESIN group has shorter operation time and less intraoperative blood loss compared to locking compression plate group（32.1 ＋/-5.6 vs 103.8 ＋/-25.2 min,t =30. 770,P =0. 000;13.9 ＋/-3.9 vs 171.0 ＋/-58.2 ml,t = 14. 246,P =0. 000） ,while there was no statistical difference in the hospital stay between the 2 groups（ 8.8 ＋/- 1.10 vs 9.1 ＋/- 1.3 days, t = 1. 006, P = 0.319 ）. The patients in the 2 groups were all followed up for 12 -36 months with a median of 25 months. All fractures united and fracture healing time was longer in ESIN group compared to locking compression plate group（ 10.7 ＋/-2.2 vs 9.3 ＋/- 1.9 weeks; t =2. 440, P =0.018 ）. According to Constant shoulder performance score ,26 patients obtained an excellent result, 1 good and 1 fair in the ESIN group;while 26 patients obtained an excellent result ,2 good and 1 fair in the locking compression plate group;there was no statistic, al difference between the 2 groups（ Z = -0. 407 ,P = 0. 684）. According to Mayo elbow performance score ,25 patients obtained an excellent resuh,2 good and 1 fair in the ESIN group;while 25 patients obtained an excellent resuh,2 good and 2 fair in the locking compression plate group ; there was no statistical difference between the 2 groups （ Z = - 0. 378, P = 0. 705 ）. No complications such as itffection, breakage of internal fixators and fracture malunion were found in the 2 groups. One case of fracture delayed - union was found in ESIN group and the fracture united at 16th week after the surgery without special treatment. Four cases of postoperative radial nerve injury were found in locking compression plate group, and the function of affected limb recovered after active functional exercises. One case of refracture was found afler removing internal fixator, and the fracture united after open reduction and locking compression plate internal fixation. There was no statistical difference in complication rates between the 2 groups （ chi （ 2 ） = 0. 802, P = 0.371 ）. Conclusion： For treatment of humeral shaft fracture in adolescents ,closed reduction internal fixation with ESIN and open reduction internal fixation with locking compression plate are similar to each other in limb function recovery, clinical curative effect and safety ; however, the former has short operation time, less injury and long fracture healing time.