动态锁定螺钉在肱骨干骨折中的临床应用

Clinical application of dynamic locking screw in treating humeral shaft fracture

目的:比较动态锁定螺钉与普通螺钉在治疗肱骨干骨折的临床疗效。方法:回顾性分析2016年1月至2018年10月诊治的46例肱骨干骨折患者的临床资料,根据内固定物不同分为动态锁定螺钉内固定组(治疗组)和普通螺钉内固定组(对照组)。其中治疗组24例,男14例,女10例,年龄20~61(36.8±10.9)岁;对照组22例,男13例,女9例,年龄19~60(35.9±12.8)岁。比较两组患者手术切口长度、手术时间、出血量、骨折愈合时间及并发症情况,并于术后3、9个月采用肩关节Constant-Murley评分和肘关节功能Mayo评分进行临床评价。结果:46例患者获得随访,时间9~43(18.6±7.9)个月。两组切口长度、手术时间、术中出血量比较差异无统计学意义(P>0.05);治疗组骨折愈合时间为(12.2±3.2)周,对照组为(15.6±4.7)周;治疗组优于对照组(P<0.05)。治疗组术后3个月肩关节Constant-Murley评分、Mayo评分分别为(84.9±5.9)分、(81.8±6.7)分,对照组分别为(74.6±9.2)分、(71.5±10.7)分;两组比较差异有统计学意义(P<0.05)。两组术后9个月肩关节Constant-Murley评分、Mayo评分比较差异无统计学意义(P>0.05)。治疗组桡神经麻痹1例;对照组延迟愈合1例,骨不连2例,断钉1例;两组比较差异无统计学意义。结论:动态锁定螺钉和普通螺钉均能有效治疗肱骨干骨折,前者在骨折愈合时间方面具有优势,早期肩肘功能恢复更好,但此项技术在国内开展时间不长,还需进一步观察大样本的远期疗效。

Objective:To compare clinical effect of dynamic locking screws and common screws in treating humeral shaft fractures.Methods:From January 2016 to October 2018,clinical data of 46 patients with humeral shaft fracture were retrospectively analyzed,which were divided into dynamic locking screw internal fixation group(treatment group)and ordinary screw internal fixation group(control group).In treatment group,there were 14 males and 10 females,aged from 20 to 61 years old with an average of(36.8±10.9)years old;22 patients in control group,there were 13 males and 9 females,aged from 19 to 60 years old with an average of(35.9±12.8)years old.Length of incision,operation time,amount of bleeding,fracture healing time and complications were compared between two groups,Constant-Murley score of shoulder joint and Mayo score of elbow joint at 3 and 9 months after operation were compared to evaluate clinical effect.Result:Forty-six patients were followed up from 9 to 43 months with an average of(18.6±7.9)months.There were no statistical differences in length of incision,operation time,amount of bleeding between two groups(P>0.05);fracture healing time in treatment group was(12.2±3.2)weeks,and(15.6±4.7)weeks in control group;there was difference between two groups(P<0.05).Constant-Murley score and Mayo score of elbow joint at 3 months after operation in treatment group were 84.9±5.9 and 81.8±6.7,while in control group were 74.6±9.2 and 71.5±10.7;there were differences between two groups(P<0.05).There were no statistical differences in Constant-Murley score and Mayo score of elbow joint between two groups at 9 months after operation(P>0.05);One patient occurred neural paralysis in treatment group;1 patient occurred delayed union,2 patients occurred bone nonunion and 1 patient occurred broken nail in control group;while there was no statistical difference between two groups in complication.Conclusion:Both of dynamic locking screws and ordinary screws could effectively treat humeral shaft fractures.dynamic locking screws has an advantage in fracture healing time,and recovery of early shoulder and elbow function.However,the active time of this technology is not too long in China,further study on long-term efficacy of large samples is needed.