锁定加压钢板与顺行交锁髓内钉治疗肱骨干骨折的中期疗效观察

Comparison of mid-term surgical results between plate and intramedullary nail for humeral shaft fracture

目的：比较切开复位锁定加压钢板与闭合复位顺行髓内钉治疗肱骨干骨折的临床疗效。方法2010年5月至2012年7月于北京积水潭医院创伤骨科接受手术治疗的肱骨干骨折患者122例，按照手术方式分为钢板组和髓内钉组，其中钢板组患者63例，髓内钉组患者59例。比较两组患者住院和手术相关指标。术后采用门诊或电话方式对患者进行定期进行随访，按照肩关节评分标准（Neer、Myao）评估患者肩、肘关节功能，采用欧洲五维健康量表（EQ－5D）评价患者生活质量。结果所有患者均顺利完成手术。两组患者住院时间、恢复工作时间和返岗率差异均无统计学意义（均P ＞0．05），髓内钉组患者手术时间、出血量、并发症发生率低于钢板组。钢板组和髓内钉组患者均完成3年以上随访，平均随访时间分别为（41．2±4．2）个月和（42．1±4．7）个月，末次随访时两组患者肩关节评分分别为（93．8±6．1）分和（92．1±4．2）分，肘关节评分为（94．9±2．9）分和（96．2±1．5）分，EQ－5D 评分为（0．92±0．06）分和（0．93±0．06）分，两组各项评分差异均无统计学意义（均 P ＞0．05）。术后所有患者均达到骨性愈合，无延迟愈合或不愈合、内固定断裂、松动、畸形愈合等情况发生。结论钢板螺钉内固定和顺行髓内钉内固定均是治疗肱骨干骨折安全、有效的手术方法。两种手术各有利弊，医生需根据患者具体情况选择合适的手术方式。

Objective To evaluate the mid-term clinical efficacy of plate and intramedullary nail for humeral shaft fracture.Methods In this retrospective study a total of 122 patients with humeral shaft fracture were divided into 2 groups according to surgery type from May 2010 to July 2012.There were 63 patients in plate group and 59 patients in intramedullary nail group.The factors related to the operation for each group were compared respectively.The clinical outcome was evaluated by the Neer scores, Myao scores and EuroQol 5 dimensions scores （EQ-5D）.All the patients were followed up periodically in the next 3 years.Results There were no significant differences between the two groups on hospital stay and time of returning to work （ P 〉0.05 ） .While the operation time, amount of intraoperative blood loss and complication rate were less in intramedullary nail group.The mean follow-up duration was （41.2 ±4.2） months in plate group and （42.1 ±4.7） months in intramedullary nail group respectively.At the last follow-up the postoperative Neer scores, Myao scores and EQ-5D scores showed no significant differences between the 2 groups[Neer：（93.8 ±6.1） vs（92.1 ±4.2）; Myao：（94.9 ±2.9） vs（96.2 ±1.5）, P 〉0.05]. There were no cases complicated with nonunion, delayed union, infection and deformity during the follow-up period.Conclusions The mid-term outcome of open reduction and internal fixation with plate and close reduction with intramedullary nail for humeral shaft fracture is satisfactory.Although both surgeries are safe and effective, they also have some defaults.The doctors should choose the right surgery carefully according to the actual situation of the patients.