背景：目前对于肱骨干骨折骨折，特别是伴有多发损伤患者的治疗以内固定修复为主，根据骨折复位方法和固定方式的不同，常用的修复方式包括髓内钉固定和微创钢板内固定。而如何选择一种最安全有效的内固定方式是肱骨干骨折修复的重点。目的：探讨髓内钉和钢板置入内固定对成人肱骨干骨折的修复效果。方法：将菏泽市立医院在2010年5月至2013年5月收治的252例肱骨干骨折患者随机均分为髓内钉组和钢板组，每组126例。髓内钉组患者采用髓内钉固定进行治疗，钢板组患者采用钢板内固定进行治疗。观察记录两组患者的手术时间、术中出血量、住院时间及骨折愈合时间等指标。内固定后随访1年，比较分析两组患者桡神经损伤、感染、骨不愈合等并发症的发生率；分别根据Neer法和Mayo法评定患者的肩关节和肘关节功能恢复情况。结果与结论：两组患者一次内固定成功率之间差异无显著性意义(χ2=0.3997，P>0.05)。髓内钉组手术时间、术中出血量、骨折愈合时间和住院时间均显著优于钢板组，两组间差异有非常显著性意义(t=15.4425，21.7134，8.2176，1.2148，P均<0.01)。内固定后随访1年，两组患者桡神经损伤发生率差异有非常显著性意义(χ2=8.2623，P<0.01)；髓内钉组骨不愈合发生率显著低于钢板组，两组间差异有显著性意义(χ2=3.9472， P <0.05）；同时髓内钉组总并发症发生率显著低于钢板组总并发症发生率，两组间差异有非常显著性意义(χ2=11.9779，P <0.01)；此外两组患者Neer肩关节功能评分和Mayo肘关节功能评分差异均无显著性意义(χ2=0.2354，0.2730，P均>0.05)。提示采用髓内钉和钢板置入内固定修复成人肱骨干骨折均可取得良好的临床效果，两种内固定方法各有优缺点，临床上应根据患者病情需要制定合适的内固定方案。%BACKGROUND:Internal fixation is the main treatment of humeral shaft fractures, especial y for cases accompanied several injuries. According to the fracture reduction method and fixation methods, the commonly used repair methods include intramedul ary nail and minimal y invasive plate. How to choose a safe and effective method of internal fixation is a hot issue in the repair of humeral shaft fractures. OBJECTIVE:To explore the clinical effect of different fixations of intramedul ary nail and plate in the treatment of adult humeral shaft fracture. METHODS:A total of 252 patients with humeral shaft fracture recruited from Heze Municipal Hospital from May 2010 to May 2013 were randomly divided into two groups, with 126 cases in each group. Patients in the two groups were treated with intramedul ary nail fixation and plate fixation, respectively. The average operation time, intraoperative blood loss, hospital stays, and healing time of fracture in the two groups were recorded. Al patients were fol owed up for 1 year postoperatively, the incidence of radial nerve injury, infection and non-union was compared. The recovery of shoulder joint and elbow joint of patients was assessed with Neer method and Mayo method, respectively. RESULTS AND CONCLUSION:After treatment, the rate of primary success of internal fixation showed no significant differences between the two groups (χ2=0.399 7, P>0.05). The average operation time, intraoperative blood loss, the healing time of fracture and hospital stays in the intramedul ary nail group were significantly shorter than that in the plate group B, the difference of the results were extremely significant in two groups (t=15.442 5, 21.713 4, 8.217 6, 1.214 8, P<0.01). After 1-year fol ow-up, the incidence of radial nerve injury showed extremely significant differences between the two groups (χ2=8.262 3, P<0.01);the incidence of nonunion in the intramedul ary nail group was significantly lower than that in the plate group, with extremely significant differences (χ2=3.947 2, P<0.05). The overal incidence of complications in intramedul ary nail group was significantly lower than that in the plate group, with extremely significant difference (χ2=11.977 9, P<0.01). Besides, the Neer scores of shoulder joint and the Mayo scores of elbow joint between the two groups had no statistical y significant difference (χ2=0.235 4, 0.273 0, P>0.05). Both intramedul ary nail and plate fixations show good clinical effect in treatment of adult humeral shaft fracture, and each technique has their advantages and disadvantages, we should choose the proper technique according to the patient’s condition.
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