锁定加压钢板与带锁髓内钉内固定治疗B型及C型肱骨干骨折的疗效比较_《中国修复重建外科杂志》

作者：

尹鹏 ^1,2 , 毛智 ¹ , 张立海 ¹ , 陶笙 ¹ , 张群 ¹ , 梁向党 ¹ , 张昊 ¹ , 龙安华 ^1,2 , 王国旗 ¹ , 唐佩福 ¹

1解放军总医院骨科分院（北京，100853）;;
2南开大学医学院;

关键词：

肱骨干骨折锁定加压钢板带锁髓内钉临床疗效

DOI：

10.7507/1002-1892.20130320

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的比较锁定加压钢板（locking compression plate，LCP）和带锁髓内钉（locked intramedullary nail，IMN）内固定治疗B、C型肱骨干骨折的疗效。方法回顾性分析2010年1月－2012年1月收治的46例B、C型肱骨干骨折患者临床资料，其中22例采用LCP内固定治疗（LCP组），24例采用IMN内固定治疗（IMN组）。两组患者性别、年龄、致伤原因、侧别、骨折部位、骨折分型、合并伤及受伤至手术时间等一般资料比较，差异均无统计学意义（P gt; 0.05），具有可比性。术后随访行临床检查和影像学评估，根据Neer肩关节评定标准和Mayo肘关节评定标准评价肩、肘关节功能。结果LCP组手术时间和术中出血量显著多于IMN组（P lt; 0.05）；两组住院时间比较，差异无统计学意义（t=0.344，P=0.733）。两组患者均获随访，随访时间12～24个月，平均16.8个月。术后6个月，LCP组1例、IMN组2例发生骨不连，骨折愈合率分别为95.5%（21/22）和91.7%（22/24），比较差异无统计学意义（χ2=0.000，P=1.000）。除骨不连患者外，LCP组骨折愈合时间为（11.77 ± 0.75）周，IMN组为（11.38 ± 0.82）周，比较差异无统计学意义（t=1.705，P=0.095）。术后两组桡神经损伤（LCP组4例、IMN组无）、肩部撞击（LCP组无、IMN组6例）发生率比较差异均有统计学意义（P lt; 0.05）；浅表性感染（LCP组1例、IMN组无）、医源性骨折（LCP组1例、IMN组2例）发生率比较差异均无统计学意义（P gt; 0.05）。术后1年，两组肩、肘关节功能评价比较，差异均无统计学意义（P gt; 0.05）。结论采用LCP和IMN内固定治疗B、C型肱骨干骨折均可取得较好疗效。使用LCP时需注意避免损伤桡神经；使用IMN时需注意将钉尾埋入大结节皮质并保护肩袖，以免发生肩部撞击。

引用本文： 尹鹏,毛智,张立海,陶笙,张群,梁向党,张昊,龙安华,王国旗,唐佩福. 锁定加压钢板与带锁髓内钉内固定治疗B型及C型肱骨干骨折的疗效比较. 中国修复重建外科杂志, 2013, 27(12): 1457-1461. doi: 10.7507/1002-1892.20130320 复制

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, 宋绍军, 等. 微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效比较. 中国修复重建外科杂志, 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.	牛学强, 黄富国, 岑石强, 等. 肱骨干骨折髓内外固定的生物力学研究. 中国修复重建外科杂志, 2008, 22(5): 516-519.
17.	赵益峰, 王满宜. 肱骨干骨折的治疗进展. 中华创伤骨科杂志, 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, 宋绍军, 等. 微创空心钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效比较. 中国修复重建外科杂志, 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. 牛学强, 黄富国, 岑石强, 等. 肱骨干骨折髓内外固定的生物力学研究. 中国修复重建外科杂志, 2008, 22(5): 516-519.
17. 赵益峰, 王满宜. 肱骨干骨折的治疗进展. 中华创伤骨科杂志, 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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锁定加压钢板与带锁髓内钉内固定治疗B型及C型肱骨干骨折的疗效比较

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《中国修复重建外科杂志》

锁定加压钢板与带锁髓内钉内固定治疗B型及C型肱骨干骨折的疗效比较

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