有限内固定结合外固定支架治疗肱骨干粉碎性骨折

Limited internal fixation combined with external fixation for comminuted humerus shaft fractures

目的探讨小切口复位有限内固定结合外固定支架治疗肱骨干粉碎性骨折的临床疗效。方法回顾性分析2005年1月～2013年1月收治的80例肱骨干粉碎性骨折患者的临床资料，按随机数字表法分为有限内固定结合外固定支架治疗组（治疗组）和切开复位钢板内固定治疗组（对照组）。治疗组40例，其中男28例，女12例；年龄21～54岁，平均33．5岁。致伤原因：交通伤18例，跌倒伤9例，压伤7例，其他6例。开放性骨折7例，闭合性骨折33例。对照组40例，其中男25例，女15例；年龄19～55岁，平均32．9岁。致伤原因：交通伤16例，跌倒伤7例，压伤7例，其他10例。开放性骨折8例，闭合性骨折32例。比较两组手术时间、术中出血量、骨折愈合时间与并发症的差异，根据Stewart和Hundley标准评定疗效。结果患者术后均获随访12～25个月，平均19个月。治疗组手术时间为（55．5±10．3）min，术中出血量为（120．4±20．7）ml，骨折愈合时间为（11．6±1．3）周，切口感染率为5％（2／40），针道感染率为8％（3／40）。根据Stewart和Hundley标准评定：优31例，良9例。对照组手术时间为（120．5±15．3）min，术中出血量为（245．4±26．7）ml，骨折愈合时间为（14．9±2．3）周，切口感染率为10％（4／40）。根据Stewart和Hundley标准：优27例，良9例，可1例，差3例。对照组1例于第2次手术取内固定物时出现桡神经损伤，2例出现骨髓炎、骨不愈合。两组手术时间、术中出血量、骨折愈合时间比较差异有统计学意义（P〈0．05），而切口感染率比较差异无统计学意义（P〉0．05）。结论小切口复位有限内固定结合外固定支架治疗肱骨干粉碎性骨折具有创伤小、操作方便、手术时间短、出血少、骨折愈合时间短等优点，其临床应用价值较大。

[Abstract] Objective To evaluate the clinical outcome in the treatment of humerus shaft eomminuted fractures using limited open reduction and internal fixation combined with an external fixator. Methods Data of 80 patients with comminuted humerus shaft fractures treated from January 2005 to January 2013 were analysed retrospectively. All the patients underwent limited open reduction and internal fixation combined with an external fixator （treatment group） and open reduction and plate fixation （control group） according to the random number table. In the treatment group, there were 40 patients （28 males, 12 females）, at mean age of 33. 5 years （range, 21-54 years）, with causes of injury including traffic accidents in five patients, falls in nine, crashes in seven and others in six. There were seven patients with open fractures and 33 with closed fractures. In the control group, there were 40 patients （25 males, 15 females） , at mean age of 32.9 years （range, 19-55 years） , with causes of injury including traffic accidents in 16 patients, tumbling in seven, crush in seven and others in ten. There were eight patients with open fractures and 32 with closed fractures. The operation time, intraoperative blood loss, bone union time and complications in both groups were recorded. Clinical efficacy was evaluated using the Stewart and Hundley standard. Results Mean follow-up was 19 months （range, 15-24 months）. Treatment and control groups showed significant differences in operation time [ （55.5 ± 10.3 ）minutes vs. （ 120.5 ±15.3 ） minutes ], intraoperative blood loss [ （ 120.4 ± 20.7 ） ml vs. （ 245.4 ± 26.7 ） ml ] and bone union time [ （ 11.6 ± 1.3 ） weeks vs. （ 14.9 ± 2.3） weeks I （P 〈 0.05 ）. Rate of incision infection was 8% （3/40） in treatment group and 10% （4/40） in control group （P 〉0. 05）. In treatment group the results were excellent in 31 patients and good in nine. In control group the results were excellent in 27 patients, good in nine, fair in one and poor in three. One patient with radial nerve injury after a second surgery for implant removal and two patients with osteomyelitis or bone nonunion were noted in control group. Conclusion Limited open reduction and internal fixation in combination with an external fixator is associated with small trauma, easy operation, short operation time, few bleeding, rigid fixation, early functional exercises and reduced bone nonunion for treatment of comminuted humerus shaft fractures, which exhibits great clinical value.