3种入路钢板内固定治疗肱骨中、下段骨折的疗效比较

Comparison effects of plate internal fixation for treatment of middle and lower humerus fractures via three kinds of approaches

目的比较3种入路钢板内固定治疗肱骨中、下段骨折的临床疗效。方法将94例采用钢板内固定治疗的肱骨中、下段骨折患者根据入路不同分为A组(采用前侧入路钢板内固定治疗,30例)、B组(采用前外侧入路钢板内固定治疗,32例)和C组(采用后侧入路钢板内固定治疗,32例)。记录3组手术情况、桡神经损伤情况及骨折愈合情况,采用HSS评分评价肘关节功能。结果患者均获得随访,时间15~24个月。3组手术时间、术中出血量、桡神经损伤发生率A组均优于B、C组(P<0.05)。A组1例骨折延迟愈合;B组2例骨折延迟愈合,2例骨折不愈合;C组2例骨折延迟愈合;以上患者经相关治疗后均愈合,其余患者均顺利愈合。末次随访时肘关节功能HSS评分优良率3组比较差异均无统计学意义(P>0.05)。结论3种入路钢板内固定治疗肱骨中、下段骨折均能得到较好的疗效,但是前侧入路具有手术时间短、术中出血量少、桡神经损伤发生少的优点。

Objective To compare the clinical efficacy of plate internal fixation in the treatment of middle and lower humerus fractures via three kinds of approaches.Methods The 94 patients with middle and lower humerus fractures treated with plate internal fixation were divided into group A(30 patients were treated with anterior plate internal fixation),group B(32 patients were treated with anterolateral plate internal fixation)and group C(32 patients were treated with posterior plate internal fixation),according to different approaches.The operation situation,radial nerve injury and fracture healing of the three groups were recorded,and the elbow joint function was evaluated by HSS score.Results All patients were followed up for 15~24 months.Operation time,intraoperative blood loss and the incidence rate of radial nerve injuries in group A were all better than those in group B,C(P<0.05).Delayed healing situation:there were 1 case of group A,2 cases of group B,and 2 cases of group C;and group B had 2 cases of nonunion.All the above patients healed after related treatment,and the remaining patients healed successfully.At the last follow-up,there was no statistical difference in HSS score of elbow function among the three groups(P>0.05).Conclusions In the treatment of middle and lower humerus fractures,the three approaches of plate internal fixation can obtain good curative effect,while the anterior approach has the advantages of short operation time,less intraoperative blood loss and less radial nerve injury.