摘要
目的比较加压钢板(LCP)、带锁髓内钉(IMN)与可膨胀髓内钉(EIMN)三种治疗方案对肱骨干骨折的中远期疗效。方法回顾性分析2011年1月-2013年12月河南省第二人民医院急诊外科收治行择期内固定术治疗的102例肱骨干骨折患者,根据手术方式分为LCP组(n=43)、IMN组(n=33)与EIMN组(n=26),比较三组的基线资料、围手术期资料与随访结果。结果术后随访48~83个月,中位随访时间66.1个月。三组的年龄、性别、致伤原因、病程、骨折分型等基线资料比较,差异无统计学意义(P>0.05)。患者均成功完成手术,无一例死亡。LCP组的手术时间、术中失血量、桡神经麻痹发生率分别为(88.6±23.5)min、(139.6±35.5)mL、16.3%,均显著高于IMN组[(75.6±20.1)min、(88.2±25.3)mL、3.0%]与EIMN组[(70.5±15.1)min、(78.8±20.9)mL、0],差异均有统计学意义(P<0.05)。LCP组无肩部不适,显著低于IMN组15.2%与EIMN组(11.5)%,差异均有统计学意义(P<0.05)。三组的住院时间、骨折部位不适发生率比较,差异均无统计学意义(P>0.05)。LCP组骨折愈合时间显著高于EIMN组,差异有统计学意义[(17.9±7.1)周vs.(13.5±7.5周),P<0.05)],而三组术后半年内骨折愈合率比较,差异无统计学意义(P>0.05)。功能康复方面,LCP组、EIMN组术后1年患肢的Constant评分即恢复到术前健肢水平(P>0.05),而IMN组术后1年患肢Constant评分仍显著低于术前健肢水平(P<0.05),在术后2年才恢复到正常(P>0.05);EIMN组、IMN组术后1年患肢Mayo评分即恢复到术前健肢水平(P>0.05),而LCP组术后1年患肢的Mayo评分仍显著低于术前健肢水平(P<0.05),在术后2年才恢复到正常(P>0.05)。组间比较,三组患者术前健肢的Constant、Mayo评分差异无统计学意义(P>0.05),具有可比性;LCP组术后1年患肢的Constant评分显著高于IMN组[(91.6±5.8)分vs.(87.8±7.2)分,P<0.05)],Mayo评分显著低于IMN组和EIMN组[(90.6±7.2)分vs.(95.6±3.9)分vs.(95.0±3.5)分,P<0.05)];三组术后2年、末次随访时的患肢Constant、Mayo评分比较,差异均无统计学意义(P>0.05)。三组患者生活质量在术后1年患肢的EQ-5D评分即达到术前健侧水平,且三组各时间点的EQ-5D评分比较,差异均无统计学意义(P>0.05)。结论 LCP为经典手术内固定方式,可应对多种肱骨干骨折。IMN与EIMN手术切口较小,对骨折断端要求较高;EIMN术后肩、肘关节功能恢复效果最佳。
Objective To compare the mid-long-term effects of three treatment schemes as locked compression plate(LCP) intramedullary nail(IMN) and expandable intramedullary nail(EIMN) for humeral shaft fractures.Methods From Jan.2011 to Dec.2013,102 patients with humeral shaft fractures who underwent elective surgery in Henan NO.2 Provincial People’s Hospital were divided into LCP group(n=43) and IMN group(n=33) and EIMN group(n=26) according to the surgical procedure.Baseline data,perioperative data,and follow-up results were compared among the three groups.Results Postoperative follow-up ranged from 48 to 83 months,with an average of 66.1 months.There was no significant difference in the baseline data of age,gender,cause of injury,duration of disease,and fracture classification among the three groups(P>0.05).All patients underwent successful operation without any death.The operation time,intraoperative blood loss and incidence of sacral nerve palsy in the LCP group were(88.6±23.5) min,(139.6±35.5) mL,and 16.3%,respectively,higher than those in the IMN group with(75.6±20.1) min,(88.2±25.3) mL,3.0% and EIMN group with(70.5±15.1) min,(78.8±20.9) mL,0%,and the difference was statistically significant(P<0.05).The incidence of shoulder discomfort in the LCP group was 0%,which was significantly lower than 15.1% in the IMN group and 11.5% in the EIMN group(P<0.05).There was no significant difference in the hospitalization time and discomfort rate of fracture site among the three groups(P>0.05).The fracture healing time of the LCP group was significantly higher than that of the EIMN group,the difference was statistically significant [(17.9±7.1) weeks vs.(13.5±7.5 weeks),P<0.05)],and the difference of the fracture healing rate of the three groups within six months after operation was not statistically significant(P>0.05).In the functional rehabilitation,the Constant score of the affected limb in the LCP group and the EIMN group was restored to the preoperative limb level(P>0.05),while the Constant score of the limb in the IMN group was still significantly lower after 1 year,which returned to normal 2 years after operation(P>0.05).The Mayo score of the affected limb in the EIMN group and the IMN group returned to the preoperative limb level 1 year aften operation(P>0.05),and the Mayo score of the limbs in the LCP group 1 year after operation was significantly lower than that of the preoperative limbs(P<0.05),and returned to normal 2 years after surgery(P>0.05).There was no significant difference in the Constant and Mayo scores of the preoperative limbs among the three groups(P>0.05).The Constant scores of the limbs 1 year after operation in the LCP group were significantly higher than those in the IMN group([91.6±5.8] min vs.[87.8±7.2],P<0.05),Mayo score was significantly lower than that in the IMN group and the EIMN group([90.6±7.2] points vs.[95.6±3.9] points vs.[95.0±3.5],P<0.05).There was no significant difference in the Constant and Mayo scores among the three groups at 2 years after operation and at the last follow-up(P>0.05).The EQ-5 D scores of the three groups reached the preoperative healthy level at 1 year after operation,and the EQ-5 D scores of the three groups at each time point were not significantly different(P>0.05).Conclusion LCP is a classic intraoperative fixation method,which can cope with a variety of humeral shaft fractures.IMN and EIMN have smaller incisions and higher requirements for fracture end;and EIMN has the best recovery effect on shoulder and elbow joint function.
作者
刘超
刘建峰
李丹
LIU Chao;LIU Jian-feng;LI Dan(Department of Emergency Surgery,Affiliated Hosital of Henan Medical College(Henan NO.2 Provincial People's Hospital),Zhengzhou 451191,China;The First Department of Bones,Affiliated Hosital of Henan Medical College(Henan NO.2 Provincial People's Hospital),Zhengzhou 451191,China;The Second Department of Bones,Affiliated Hospital of Henan Medical College(Henan NO.2 Provincial People's Hospital),Zhengzhou 451191,China)
出处
《创伤外科杂志》
2019年第6期425-430,共6页
Journal of Traumatic Surgery
关键词
肱骨骨折
内固定
髓内钉
钢板
康复
humeral fracture
internal fixation
intramedullary nail
plate
rehabilitation
