鎖定加壓鋼板與帶鎖髓內釘內固定治療B型及C型肱骨干骨折的療效比較_《中國修復重建外科雜志》

作者：

尹鵬 ^1,2 , 毛智 ¹ , 張立海 ¹ , 陶笙 ¹ , 張群 ¹ , 梁向黨 ¹ , 張昊 ¹ , 龍安華 ^1,2 , 王國旗 ¹ , 唐佩福 ¹

1解放軍總醫院骨科分院（北京，100853）;;
2南開大學醫學院;

關鍵詞：

肱骨干骨折鎖定加壓鋼板帶鎖髓內釘臨床療效

DOI：

10.7507/1002-1892.20130320

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目的比較鎖定加壓鋼板（locking compression plate，LCP）和帶鎖髓內釘（locked intramedullary nail，IMN）內固定治療B、C型肱骨干骨折的療效。方法回顧性分析2010年1月－2012年1月收治的46例B、C型肱骨干骨折患者臨床資料，其中22例采用LCP內固定治療（LCP組），24例采用IMN內固定治療（IMN組）。兩組患者性別、年齡、致傷原因、側別、骨折部位、骨折分型、合并傷及受傷至手術時間等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。術后隨訪行臨床檢查和影像學評估，根據Neer肩關節評定標準和Mayo肘關節評定標準評價肩、肘關節功能。結果LCP組手術時間和術中出血量顯著多于IMN組（P lt; 0.05）；兩組住院時間比較，差異無統計學意義（t=0.344，P=0.733）。兩組患者均獲隨訪，隨訪時間12～24個月，平均16.8個月。術后6個月，LCP組1例、IMN組2例發生骨不連，骨折愈合率分別為95.5%（21/22）和91.7%（22/24），比較差異無統計學意義（χ2=0.000，P=1.000）。除骨不連患者外，LCP組骨折愈合時間為（11.77 ± 0.75）周，IMN組為（11.38 ± 0.82）周，比較差異無統計學意義（t=1.705，P=0.095）。術后兩組橈神經損傷（LCP組4例、IMN組無）、肩部撞擊（LCP組無、IMN組6例）發生率比較差異均有統計學意義（P lt; 0.05）；淺表性感染（LCP組1例、IMN組無）、醫源性骨折（LCP組1例、IMN組2例）發生率比較差異均無統計學意義（P gt; 0.05）。術后1年，兩組肩、肘關節功能評價比較，差異均無統計學意義（P gt; 0.05）。結論采用LCP和IMN內固定治療B、C型肱骨干骨折均可取得較好療效。使用LCP時需注意避免損傷橈神經；使用IMN時需注意將釘尾埋入大結節皮質并保護肩袖，以免發生肩部撞擊。

引用本文： 尹鵬,毛智,張立海,陶笙,張群,梁向黨,張昊,龍安華,王國旗,唐佩福. 鎖定加壓鋼板與帶鎖髓內釘內固定治療B型及C型肱骨干骨折的療效比較. 中國修復重建外科雜志, 2013, 27(12): 1457-1461. doi: 10.7507/1002-1892.20130320 復制

1.	Ekholm R, Adami J, Tidermark J, et al. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg (Br), 2006, 88(11): 1469-1473.
2.	Mahabier KC, Vogels LM, Punt BJ, et al. Humeral shaft fractures: retrospective results of non-operative and operative treatment of 186 patients. Injury, 2013, 44(4): 427-430.
3.	Chen F, Wang Z, Bhattacharyya T. Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study. J Orthop Trauma, 2013, 27(2): 68-72.
4.	Tsai CH, Fong YC, Chen YH, et al. The epidemiology of traumatic humeral shaft fractures in Taiwan. Int Orthop, 2009, 33(2): 463-467.
5.	Gardner MJ, Griffith MH, Demetrakopoulos D, et al. Hybrid locked plating of osteoporotic fractures of the humerus. J Bone Joint Surg (Am), 2006, 88(9): 1962-1967.
6.	Putti AB, Uppin RB, Putti BB. Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong), 2009, 17(2): 139-141.
7.	Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop, 2010, 34(4): 571-576.
8.	Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007, 31(3): 391-395.
9.	曹烈虎, 翁蔚宗, 宋紹軍, 等. 微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效比較. 中國修復重建外科雜志, 2013, 27(4): 418-422.
10.	Lan X, Zhang LH, Tao S, et al. Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures. Chin Med J (Engl), 2013, 126(12): 2337-2342.
11.	Koch PP, Gross DF, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg, 2002, 11(2): 143-150.
12.	Ekholm R, Tidermark J, Tornkvist H, et al. Outcome after closed functional treatment of humeral shaft fractures. J Orthop Trauma, 2006, 20(9): 591-596.
13.	Sarmiento A, Zagorski JB, Zych GA, et al. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg (Am), 2000, 82(4): 478-486.
14.	Zatti G, Teli M, Ferrario A, et al. Treatment of closed humeral shaft fractures with intramedullary elastic nails. J Trauma, 1998, 45(6): 1046-1050.
15.	Ouyang H, Xiong J, Xiang P, et al. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg, 2013, 22(3): 387-395.
16.	牛學強, 黃富國, 岑石強, 等. 肱骨干骨折髓內外固定的生物力學研究. 中國修復重建外科雜志, 2008, 22(5): 516-519.
17.	趙益峰, 王滿宜. 肱骨干骨折的治療進展. 中華創傷骨科雜志, 2010, 12(7): 973-975.
18.	Kesemenli CC, Subasi M, Arslan H, et al. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc, 2003, 37(2): 120-125.
19.	Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3): 162-166.

1. Ekholm R, Adami J, Tidermark J, et al. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg (Br), 2006, 88(11): 1469-1473.
2. Mahabier KC, Vogels LM, Punt BJ, et al. Humeral shaft fractures: retrospective results of non-operative and operative treatment of 186 patients. Injury, 2013, 44(4): 427-430.
3. Chen F, Wang Z, Bhattacharyya T. Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study. J Orthop Trauma, 2013, 27(2): 68-72.
4. Tsai CH, Fong YC, Chen YH, et al. The epidemiology of traumatic humeral shaft fractures in Taiwan. Int Orthop, 2009, 33(2): 463-467.
5. Gardner MJ, Griffith MH, Demetrakopoulos D, et al. Hybrid locked plating of osteoporotic fractures of the humerus. J Bone Joint Surg (Am), 2006, 88(9): 1962-1967.
6. Putti AB, Uppin RB, Putti BB. Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong), 2009, 17(2): 139-141.
7. Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop, 2010, 34(4): 571-576.
8. Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007, 31(3): 391-395.
9. 曹烈虎, 翁蔚宗, 宋紹軍, 等. 微創空心釘與切開復位鋼板內固定治療肱骨大結節骨折的療效比較. 中國修復重建外科雜志, 2013, 27(4): 418-422.
10. Lan X, Zhang LH, Tao S, et al. Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures. Chin Med J (Engl), 2013, 126(12): 2337-2342.
11. Koch PP, Gross DF, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg, 2002, 11(2): 143-150.
12. Ekholm R, Tidermark J, Tornkvist H, et al. Outcome after closed functional treatment of humeral shaft fractures. J Orthop Trauma, 2006, 20(9): 591-596.
13. Sarmiento A, Zagorski JB, Zych GA, et al. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg (Am), 2000, 82(4): 478-486.
14. Zatti G, Teli M, Ferrario A, et al. Treatment of closed humeral shaft fractures with intramedullary elastic nails. J Trauma, 1998, 45(6): 1046-1050.
15. Ouyang H, Xiong J, Xiang P, et al. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg, 2013, 22(3): 387-395.
16. 牛學強, 黃富國, 岑石強, 等. 肱骨干骨折髓內外固定的生物力學研究. 中國修復重建外科雜志, 2008, 22(5): 516-519.
17. 趙益峰, 王滿宜. 肱骨干骨折的治療進展. 中華創傷骨科雜志, 2010, 12(7): 973-975.
18. Kesemenli CC, Subasi M, Arslan H, et al. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc, 2003, 37(2): 120-125.
19. Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3): 162-166.

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鎖定加壓鋼板與帶鎖髓內釘內固定治療B型及C型肱骨干骨折的療效比較

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《中國修復重建外科雜志》

鎖定加壓鋼板與帶鎖髓內釘內固定治療B型及C型肱骨干骨折的療效比較

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