三种内固定方式治疗肱骨干中下段骨折的短期疗效比较

Short-term efficacy comparison of three internal fixation methods in the treatment of middle and lower humeral shaft fractures

目的比较三种手术内固定方式治疗肱骨中下段骨折的临床疗效。方法回顾性分析2015年1月-2017年12月内蒙古医科大学第二附属医院收治的79例肱骨中下段骨折患者临床资料,其中A组33例,采用闭合复位交锁髓内钉内固定术;B组27例,采用前正中入路切开复位钢板内固定术;C组19例,采用后外侧入路切开复位钢板内固定术。比较三组的手术时间、术中出血量、桡神经损伤发生情况等。结果所有患者均获随访,随访时间为8~16个月。⑴手术时间、术中出血量为A组<B组<C组(Z=65.946、1583.274,P<0.05);⑵临床愈合时间、骨性愈合时间为A组<B组和C组(Z=57.334、56.625,P<0.05),B组和C组差异无统计学意义;⑶术后1周、1个月三组肘关节活动度比较A组>B组>C组(Z=631.053、147.477,P<0.05);术后3个月,三组肘关节活动度差异无统计学意义;⑷术后1周、1个月Mayo肘关节功能评分比较A组>B组>C组(F=277.564、126.004,P<0.05);术后3个月Mayo肘关节功能评分比较A组>B组和C组(F=17.734,P<0.05),B组和C组差异无统计学意义;⑸术后1周,三组Neer肩关节功能评分比较B组>C组>A组(F=934.931,P<0.05);术后1个月,三组Neer肩关节功能评分差异无统计学意义;⑹组内比较:三组不同时间肘关节活动度和Mayo肘关节功能评分随时间逐渐提高(F=257.292、1227.227、671.275,P<0.05;F=75.939、138.137、415.356,P<0.05);三组术后1个月Neer肩关节功能评分均高于术后1周(F=5876.663、31.371、381.230,P<0.05);⑺B、C两组分别有1例术后早期感染,C组有2例术后出现桡神经支配区麻木。结论交锁髓内钉固定治疗肱骨中下段骨折明显优于前正中入路切开复位钢板内固定以及后外侧入路切开复位钢板内固定。无法采用髓内钉固定者,可考虑前正中入路或后外侧入路切开复位钢板螺钉内固定。

Objective To compare the therapeutic efficiency of three internal fixation methods in the treatment of mid-distal humeral shaft fractures.Methods Clinical data of 79 cases of mid-distal humeral shaft fractures from January 2015 to December 2017 in the Second Affiliated Hospital of Inner Mongolia Medical University were selected and were analyzed with retrospective method.Data were divided into three groups according to the methods of treatment.In group A,33 cases were treated with closed reduction and interlocking intramedullary nail fixation.In group B,27 cases were treated with anterior and median approach open reduction and internal fixation with steel plate.In group C,19 cases were treated with posterior lateral approach open reduction and internal fixation with steel plate.The operative time,intraoperative blood loss and radial nerve injury were compared among three groups.Results All patients were followed up for 8 to 16 months.Comparison among groups:The operation time and the intraoperative blood loss:group A<group B<group C(Z=65.946、1583.274,P<0.05);The clinical healing time and the bone healing time:group A<group B/group C(Z=57.334、56.625,P<0.05).There was no significant difference between group B and group C;The range of motion(ROM)of elbow joint at one week and one month after operation:group A>group B>group C(Z=631.053、147.477,P<0.05).Concerning the ROM at the third months after operation,there was no significant difference among three groups;Mayo elbow function score at the first week and the first month after operation:group A>group B>group C(F=277.564、126.004,P<0.05);Mayo elbow function score at the 3rd month after operation:group A>group B/group C(F=17.734,P<0.05).There was no significant difference between group B and group C;Neer shoulder function score at the first week after operation:group B>group A>group C(F=934.931,P<0.05).Concerning Neer shoulder function score at the first month after operation,there was no significant difference among three groups.Comparison within group:There was significant difference among three groups concerning the ROM of elbow joint and Mayo elbow function score at different times:three months after operation>one month>one week(F=257.292、1227.227、671.275,P<0.05;F=75.939、138.137、415.356,P<0.05);There was significant difference among three groups concerning Neer shoulder function score at different times:one month after operation>one week(F=5876.663、31.371、381.230,P<0.05).One case of early postoperative infection occurred in group B and C.In group C,there were 2 cases of radial nerve injury after operation.Conclusion Interlocking intramedullary nail fixation in the treatment of mid-distal humeral shaft fractures is superior to open reduction and internal fixation with steel plate.For those who can not be fixed with intramedullary nail fixation,anterior and posterior-lateral approach open reduction and internal fixation with steel plate is recommended.