肱骨后外侧钢板与前外侧钢板治疗肱骨中下段关节外骨折的疗效比较

Comparison of efficacy of posterolateral and anterolateral locking plate fixation in treatment of extra-articular distal humeral shaft fractures

目的探讨肱骨后外侧钢板与前外侧钢板治疗肱骨中下段关节外骨折的临床效果。方法采用回顾性病例对照研究分析2014年1月—2016年10月天津医院收治的52例肱骨中下段关节外骨折患者临床资料,其中男32例,女20例;年龄18-56岁[(36.9±10.9)岁]。骨折AO/OTA分型:A型15例,B型32例,C型5例。23例采用肱骨远端后外侧解剖锁定钢板固定(A组),29例采用肱骨前外侧锁定钢板固定(B组)。比较两组手术时间、术后骨折愈合时间,末次随访时评价患肢肘关节屈伸活动范围、梅奥肘关节功能评分及并发症发生率。结果患者均获随访12-20个月[(13.7±2.2)个月]。A、B组手术时间分别为(79.8±9.6)min、(85.0±11.6)min,骨折愈合时间分别为(4.1±1.0)个月、(4.1±1.0)个月(P均>0.05)。肘关节伸直角度A组为3.9°(0.0°,5.0°),B组为4.4°(0.0°,5.0°);屈曲角度A组为127.4°(125.0°,132.5°),B组为128.5°(122.5°,132.5°)(P均>0.05)。梅奥肘关节功能评分A组为91.0(90.0,93.5)分,B组为90.2(90.0,92.5)分(P>0.05)。术后A组出现桡神经损伤2例(9%),B组出现桡神经损伤3例(10%)(P>0.05),症状均于术后3个月内消退。结论对于肱骨干中下段关节外骨折,后外侧钢板及前外侧钢板均能取得满意的临床效果。但后外侧钢板放置可以更靠近远端,多向锁定设计更加稳定,对于骨折线接近肘关节的患者更有优势。

Objective To compare the effect of posterolateral plate and anterolateral locking plate in surgical treatment for extra articular distal humeral shaft fractures.Methods A retrospective case control study was made on 52 patients with extra-articular distal humeral shaft fractures admitted in Tianjin Hospital from January 2014 to October 2016.There were 32 males and 20 females,with the age from 18 to 56 years[(36.9±10.9)years].According to the AO/OTA classification,there were 15 patients with type A,32 type B,and 5 type C.Twenty three patients were treated with osterolateral locking plate(Group A)and 29 with anterolateral locking plate(Group B).Operation time,bone union time,range of motion of the elbow,Mayo elbow performance score and complication rate were evaluated.Results All patients were followed up for 12-20 months[(13.7±2.2)months].Operation time was(79.8±9.6)minutes in Group A and(85.0±11.6)minutes in Group B(P>0.05).Bone union time was(4.1±1.0)months in Group A and(4.1±1.0)months in Group B(P>0.05).Degrees of elbow extension was 3.9°(0.0°,5.0°)in Group A,and 4.4°(0.0°,5.0°)in Group B(P>0.05).Degrees of elbow flexion was 127.4°(125.0°,132.50°)in Group A and 128.5°(122.5°,132.5°)in Group B(P>0.05).Mayo elbow performance score was 91.0(90.0,93.5)points in Group A and 90.2(90.0,92.5)points in Group B(P>0.05).Radial nerve damage was noted after operation,showing no significant difference between two groups[2 patients(9%)in Group A and 3 patients(10%)in Group B](P>0.05),and the symptoms were recovered in all patients within 3 months.Conclusions Both the posterolateral and anterolateral locking plate are effective in surgical treatment for extra-articular distal humeral shaft fractures.However,the posterolateral plate can be placed closer to the distal end of the humerus and the multi-directional locking design is more stable,which has advantages for the patient with fracture line close to the elbow joint.