肱骨干骨折手术与非手术治疗的比较

doi:10.3969/j.issn.1671-167X.2017.05.019

摘要/Abstract

摘要： 目的比较肱骨干骨折手术与非手术治疗方法的临床疗效,以期指导临床选择。方法连续入选2005年3月至2012年10月间有完整随访资料的患者252例,根据治疗方法的不同将患者分为保守治疗组和手术内固定组,其中保守治疗组76例使用石膏或小夹板固定骨折,手术内固定组176例使用切开复位钢板或髓内针固定骨折。对两组间并发症发生率、骨折愈合时间、骨折愈合率、Constant-Murley肩关节功能评分和Mayo肘关节功能评分等参数进行比较。结果平均随访(31.24±20.06)个月。两组数据在年龄、开放骨折数量、骨折部位和AO(Arbeitsgemeinschaft für Osteosynthesefragen)分类方面差异没有统计学意义。骨折愈合率:保守治疗组96.1%(73/76),手术内固定组97.7%(172/176),P=0.46;骨折愈合时间:保守治疗组(10.24±2.93)周,手术内固定组(10.69±2.51)周,P=0.22;并发症发生率: 保守治疗组5.3%(4/76例),手术内固定组15.3% (27/176例),P=0.025;其中骨折不愈合率:保守治疗组3.95%(3/76),手术内固定组2.3%(4/176), P=0.43; 桡神经损伤:保守治疗组0%(0/76),手术内固定组5.7%(10/176), P=0.035; 骨劈裂: 保守治疗组0%(0/76),手术内固定组1.7%(3/176), P=0.556; 肘僵硬: 保守治疗组1.3%(1/76),手术内固定组0.6%(1/176), P=1.000; 肩痛:保守治疗组0%(0/76),手术内固定组5.1%(9/176), P=0.061。Constant-Murley肩关节功能评分:保守治疗组(97.37±4.94)分,手术内固定组(96.34±6.88)分,P=0.24;Mayo肘关节功能评分:保守治疗组(99.80±1.72)分,手术内固定组(99.49±2.73)分,P=0.36。结论肱骨干骨折保守治疗与手术治疗的疗效相当,但并发症少。

关键词: 肱骨干骨折, 石膏, 小夹板, 钢板, 带锁髓内针

Abstract: Objective: To compare the difference between non-operative and operative treatment of humeral shaft fractures. Methods: From March 2005 to October 2012, 252 cases of humeral shaft fractures were treated and were adequately followed up. According to the treatment methods, the patients were divided into 2 groups: the non-operative group and the operative group. In the non-operative group, there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with internal fixation either by plating or by nailing in the operative group. The follow-up parameters included: fracture healing rate, fracture union time, complications rate, Constant- Murley shoulder score and Mayo elbow score. Results: The mean follow-up period was (31.24±20.06) months (ranging 6 to 103 months). There were no statistical differences in age, open fracture number, fracture site and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification between the non-operative group and the operative group. The fracture healing rate: the non-operative group: 96.1%(72/76), the operative group: 97.7%(172/176), P=0.46; the fracture union time: the non-operative group: (10.24±2.93) weeks, the operative group: (10.69±2.51) weeks, P=0.22; the complication rate: the non-operative group: 5.3%(4/76),the operative group: 15.3%(27/176), P=0.03. The complications included: nonunion: the non-operative group: 3.95%(3/76), the operative group: 2.3%(4/176), P=0.434; radial nerve palsies: the non-operative group: 0%(0/76), the operative group: 5.7%(10/176), P=0.035; bone split: the non-operative group: 0%(0/76), the operative group: 1.7%(3/176), P=0.556; elbow stiffness: the non-operative group:1.3%(1/76), the operative group: 0.6%(1/176), P=1.000; shoulder pain: the non-operative group:0%(0/76), the operative group: 5.1%(9/176), P=0.061. The Constant-Murley shoulder score: the non-operative group: 97.37±4.94, the operative group: 96.34±6.88, P=0.244. The Mayo elbow score: the non-operative group: 99.80±1.72, the operative group: 99.49±2.73,P=0.923. Conclusion: The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.

Key words: Humeral shaft fracture, Plaster, Small splint, Plate, Interlocking intramedullary nail

中图分类号:

R683.41

张伯松, 李文毅, 刘兴华, 危杰, 贺良, 王满宜. 肱骨干骨折手术与非手术治疗的比较[J]. 北京大学学报(医学版), 2017, 49(5): 851-854.

ZHANG Bo-song, LI Wen-yi, LIU Xing-hua, WEI Jie, HE Liang, WANG Man-yi. Comparative results of non-operative and operative treatment of humeral shaft fractures[J]. Journal of Peking University(Health Sciences), 2017, 49(5): 851-854.

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