闭合复位髓内钉技术治疗肱骨干骨折的疗效观察

Long-term Clinical Efficacy of Minimally Invasive Treatment for Humeral Shaft Fractures with Intramedullary Nails

目的评估闭合复位髓内钉技术治疗肱骨干骨折的临床疗效,总结临床经验。方法 2010年5月至2012年7月应用交锁髓内钉治疗肱骨干骨折患者68例,其中男31例,女37例,年龄22-71岁,平均44.5岁。骨折按AO分型,A型51例,B型11例,C型6例。所有患者均采用顺行髓内钉,骨折断端均为闭合复位,未予切开。术后患者即刻保护下功能锻炼。出院后患者进行定期随访。按照Constant评分评估患者肩关节功能,EuroQol健康指数量表（EQ-5D）评价患者生活质量。结果所有患者均顺利完成手术,切口均为Ⅰ期愈合。采用门诊或电话随访的方式对所有患者完成3年以上随访,平均随访时间44.3个月（38-52个月）。末次随访时根据肩关节功能Constant评分,优39例（57.4%）,良24例（35.3%）,可3例（4.4%）,差2例（2.9%）,优良率达92.7%;EQ-5D评分显示患者生活质量较伤前差异无统计学意义（P〉0.05）。所有患者骨折均达到骨性愈合,无延迟愈合或不愈合,无断钉、畸形愈合等情况发生。结论闭合复位髓内钉技术是治疗肱骨干骨折安全、有效的手术方法。

Objective To evaluate the efficacy of the intramedullary nail technique for humeral shaft fractures. Methods From May 2010 to July 2012,68 cases of humeral shaft fractures with average age of 44. 5 year-old（ 22 - 71） who received closed reduction and intramedullary nail fixation were included in this retrospective study. There were 31 males and 37 females. According to AO classification,51 cases were type A,11 cases were type B,6 cases were type C. All the humeral shaft fractures received close reduction and antegrade intramedullary nail fixation. No open technique was used. All patients received rehabilitation after surgery immediately and were followed up periodically after discharge. The mean follow-up period was 44. 3months（ range 38 to 52 months）. The Constant scores and Euro Qol 5 dimensions scores（ EQ-5D） were applied to evaluate the shoulder function and life quality after surgery. Results All the operations were performed successfully. No wound complication was observed. The data of clinical outcomes were obtained by outpatient visiting and telephone periodically. At the last follow-up there were 39（ 57. 4%） excellent,24（ 35. 3%） good,3（ 4. 4%） fair,2（ 2. 9%） poor according to the Constant scores with total excellent to good rate up to 92. 7%. The EQ-5D scores showed the life quality were similar with that before injury（ P 〉0. 05）. There was no case complicated with nonunion,delayed union,infection and deformity during the follow-up period.Conclusion As an effective minimally invasive treatment for humeral shaft fractures,close reduction and intramedullary nail fixation can ensure reliable clinical outcome with less complications,and early function recovery.