外固定架与钢板内固定治疗肱骨投弹骨折比较

External fixator versus plate internal fixation for humeral shaft fracture secondary to hand grenade throwing

摘要:

［目的］比较外固定架与钢板内固定治疗肱骨投弹骨折的临床疗效。［方法］回顾性分析 2016 年 1 月—2020 年 1 月 60 例肱骨投弹骨折患者的临床资料，依据医患沟通结果，30 例采用外固定架固定，必要时增加小切口拉力螺钉固定（外固定组），30 例采用钢板内固定（内固定组）。比较两组术前一般资料、围手术期情况、随访结果和影像资料。［结果］术中桡神经损伤外固定组为 1 例，内固定组为 6 例，差异有统计学意义 （P<0.05）。外固定组切口长度和术中出血量显著优于内固定组 （P<0.05）。两组患者随访 （14.23±1.89） 个月。外固定组术后开始主动活动时间和完全负重活动时间显著早于内固定组 （P< 0.05）。随术后时间推移，两组肘伸屈 ROM、肩上举 ROM 及 MEPS 、Constant-Murley 评分均逐渐增加，且外固定组肘伸屈 ROM 及 MEPS 评分优于内固定组，差异均有统计学意义 （P<0.05），但两组间肩上举 ROM 及 Constant-Murley 评分差异无统计学意义 （P>0.05）。影像显示两组骨折复位质量的差异无统计学意义 （P>0.05）。但外固定组骨折愈合时间显著早于内固定组 （P<0.05）。［结论］ 外固定架与钢板内固定均为治疗肱骨投弹骨折的较好方法。外固定架固定具有手术创伤小、并发症少的优势，骨折可早期愈合。

Abstract:

[Objective] To compare the clinical outcomes of external fixator versus plate internal fixation for humeral shaft fracture sec- ondary to hand grenade throwing. [Methods] A retrospective study was done on 60 patients who underwent surgical treatment for humeral shaft fracture secondary to hand grenade throwing from January 2016 to January 2020. According to the doctor-patient communication pre- operatively, 30 patients had the fracture fixed with an external fixator, if necessary, lag screws by a small incision were added (the EF group) , while the remaining 30 patients were treated with plate for internal fixation (the IF group) . The preoperative general data, periopera- tive conditions, follow-up results and imaging data of the two groups were compared. [Results] The intraoperative radial nerve injury hap- pened in 1 case of the EF group, while 6 cases of the IF group, which was statistically significant (P<0.05) . The EF group proved signifi- cantly superior to the IF group in terms of incision length and intraoperative blood loss (P<0.05) . During the follow-up lasted for (14.23± 1.89) months, the EF group resumed active activity and full weight-bearing activity significantly earlier than the IF group (P<0.05) . The el- bow flexion- extension range of motion (ROM) , shoulder forward lifting ROM, MEPS and Constant-Murley score improved gradually in both groups. The EF group was significantly superior to the IF group in elbow ROM and MEPS scores (P<0.05) , but there was no signifi- cant difference in shoulder ROM and Constant-Murley score between the two groups at 6 and 12 months postoperatively (P<0.05) . Radio- graphically, although no a significant difference in fracture reduction quality was found between the two groups (P>0.05) , the EF group had fracture healing on images significantly earlier than the IF group (P<0.05) . [Conclusion] Both external fixator and plate internal fixation are suitable techniques for the treatment of humeral shaft fracture secondary to hand grenade throwing. By comparison, the EF has the ad- vantages of minimizing surgical trauma, declining complications and earlier fractur healing.