目的:肱骨远端第三骨折治疗困难。研究表明,前路微创钢板术后并发症发生率较低,治愈率较高。然而,目前没有适用的解剖板。本研究旨在探讨髓内钉联合前路微创钢板治疗肱骨干远端骨折的临床效果。
方法:对2015年9月至2020年1月收治的83例肱骨干下段骨折患者资料进行分析。根据不同的治疗方法,分为两组:40例患者采用髓内钉联合微创前路钢板固定术(A组),43例患者采用后路双钢板内固定治疗(B组)。术前一般资料,手术时间,术中失血,总切口长度,骨折愈合时间,肩肘视觉模拟量表(VAS)评分,Constant-Murley肩关节功能评分,梅奥肘关节功能评分,记录并比较两组患者的并发症。采用两个独立的样本t检验进行随访,年龄,BMI,操作时间,术中出血,总切口长度,骨折愈合时间,Constant-Murley得分和Mayo得分,肩、肘VAS评分采用秩和检验。
结果:两组术前一般资料无明显差异(p>0.05),表明可比性。手术时间无明显差异,总切口长度,骨折愈合时间,最后一次随访时Constant-Murley肩关节功能评分,梅奥肘关节功能评分,2组患者肩肘VAS疼痛评分差异有统计学意义(p>0.05)。观察组术中出血量为76.98±16.46,明显少于对照组,差异有统计学意义(p<0.01)。没有桡神经损伤,肌皮神经损伤,观察组患者切口感染及骨折不愈合。在对照组中,医源性桡神经损伤4例,发现3例切口感染和3例骨折不愈合。并发症发生率为23.3%(10/43)。两组并发症发生率差异有统计学意义(p<0.01)。
结论:肱骨髓内钉联合前路微创钢板治疗肱骨干远端骨折具有软组织损伤少的优点。减少输血,骨折愈合率高,医源性桡神经损伤风险低,是临床治疗该类骨折的有效方法。
OBJECTIVE: The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures.
METHODS: The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow.
RESULTS: There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01).
CONCLUSIONS: A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.