钢板及髓内钉治疗桡骨干骨折的对比分析

摘要/Abstract

摘要： 目的比较钢板及髓内钉治疗桡骨干骨折对桡骨旋转弓的恢复情况。方法回顾分析2021年10月—2023年9月东平县人民医院收治的60例住院患者,所有被纳入的患者均为单侧桡骨干骨折（合并或不合并同侧尺骨干骨折）,均选择手术方式,选择钢板或髓内钉为主要内固定方式进行治疗。根据内固定方式分为两组,共32例患者选择使用钢板内固定,共28例患者选择使用髓内钉内固定。记录两组患者手术时间、切口长度、术后最大桡骨弧度定点值、骨折愈合时间、肘腕关节活动度、术后6月前臂旋转度、DASH评分和Grace-Eversman评分等。结果患者术后均于东平县人民医院放射科拍摄前臂正侧位X线片。经观察研究,髓内钉组在手术时间及切口长度方面均优于钢板组,差异有统计学意义（P<0.05）。两组在最大桡骨弧度定点值方面相比,差异无统计学意义（P>0.05）。两组在骨折愈合时间与肘腕关节活动度（末次随访）患健侧比值方面相比,差异无统计学意义（P>0.05）。两组在术后6月屈肘90°中立位前臂旋转度（旋前、旋后）方面相比,差异无统计学意义（P>0.05）。两组在DASH与Grace-Eversman 评分方面相比,差异无统计学意义（P>0.05）。结论两种内固定方式治疗桡骨干骨折对桡骨旋转弓均能取得良好的恢复,选择髓内钉治疗较钢板治疗切口更小、手术时间更短。

关键词: 桡骨干骨折, 桡骨旋转弓, 钢板, 髓内钉

Abstract: Objective To compare the recovery of the radial rotation arch in the treatment of radial shaft fractures with steel plates and intramedullary nails. Methods A retrospective analysis was conducted on 60 hospitalized patients at Dongping County People's Hospital from October 2021 to September 2023. All included patients had unilateral radial shaft fractures (with or without ipsilateral ulnar shaft fractures) and chose surgical methods, with steel plates or intramedullary nails as the main internal fixation methods for treatment.According to the internal fixation method, A total of 32 patients chose to use steel plate internal fixation.Record the surgical time, incision length, maximum radial curvature after surgery, fracture healing time, range of motion of elbow wrist joint, forearm rotation at 6 months after surgery, DASH score, Grace Eversman score, etc. for two groups of patients. Results All patients underwent forearm anteroposterior and lateral X-ray films at the Radiology Department of Dongping County People's Hospital after surgery. After observation and research, it was found that the intramedullary nail group was superior to the steel plate group in terms of surgical time and incision length, and the difference was statistically significant (P<0.05). There was no statistically significant difference (P>0.05) between the two groups in terms of the fixed point value of maximum radius curvature. In terms of the ratio between the affected and healthy sides, there was no statistically significant difference (P>0.05) between the two groups in terms of fracture healing time and elbow wrist joint range of motion (last follow-up). There was no statistically significant difference (P>0.05) between the two groups in terms of forearm rotation (pronation and supination) in the neutral position at 90 ° elbow flexion 6 months after surgery. There was no statistically significant difference (P>0.05) between the two groups in terms of DASH and Grace Eversman scores. Conclusion Both internal fixation methods for treating radial shaft fractures can achieve good recovery of the radial rotation arch. The choice of intramedullary nail treatment has a smaller incision and shorter surgical time compared to steel plate treatment.

Key words: radial shaft fracture, radial rotating arch, steel plate, intramedullary nail

中图分类号:

R687.3

潘飞, 吴昊. 钢板及髓内钉治疗桡骨干骨折的对比分析[J]. 中华养生保健, 2024, 42(24): 14-17.

Pan Fei, Wu Hao. Comparative Analysis of Steel Plate and Intramedullary Nail in the Treatment of Radial Shaft Fractures[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(24): 14-17.

参考文献

[1] 何红英,竺得洲,蓝云,等.髓内钉与钢板治疗成人前臂双骨折的疗效分析[J].中国骨与关节杂志,2019,8(11):820-825.
[2] 孙明,王蔚文.临床疾病诊断与疗效判断标准(第一版)[M].北京:科学技术文献出版社, 2010.
[3] GRACE T G, EVERSMANN W W JR. Forearm fractures: treatment by rigid fixation with early motion[J].J Bone Joint Surg Am,1980,62(3):433-438.
[4] HUDAK P L, AMADIO P C, BOMBARDIER C.Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The upper extremity collaborative group (UECG)[J].Am J Ind Med,1996,29(6):602-608.
[5] 王亦璁. 骨与关节损伤(第五版)[M].北京:人民卫生出版社,2015,862.
[6] 谢晓飞. 髓内针与接骨板治疗成人尺桡骨干骨折的临床疗效分析[D].大连:大连医科大学,2018.
[7] 田伟. 积水潭骨科教程(第二版)[M].北京:北京大学医学出版社,2018:199-200.
[8] 张海波,王晓,付新杰,等.掌侧Henry入路在桡骨干骨折手术治疗中的临床应用[J].中国矫形外科杂志,2011,19(4):292-295.
[9] ZHAO L, WANG B, BAI X, et al.Plate fixation versus intramedullary nailing for both-bone forearm fractures:a Meta-analysis of randomized controlled trials and cohort studies[J].World J Surg,2017,41(3):722-733.
[10] 屈继宁,郭华,颉强.闭合复位弹性髓内钉固定术与切开复位钢板内固定术治疗儿童尺桡骨干骨折的临床效果[J].临床医学研究与实践,2019,4(9):1-2,5.
[11] KOSE A, AYDIN A, EZIRMIK N, et al.Alternative treatment of forearm double fractures: new design intramedullary nail[J]. Arch Orthop Trauma Surg,2014,134(10):1387-1396.
[12] BARTOLOTTA R J, DANIELS S P, VERRET C I, et al.Current Fixation Options for Elbow,Forearm,Wrist,and Hand Fractures[J].Semin Musculoskelet Radiol,2019,23(2):109-125.
[13] 刘远翔,李皓桓,彭飞等.采用双髓内钉内固定术治疗尺、桡骨干双骨折的临床疗效观察[J].临床外科杂志,2015,23(2):138-140.
[14] KÓSE A, AYDÍN A, EZIRMIK N, et al. A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures[J].Ulus Travma Acil Cerrahi Derg,2017,23(3):235-244.
[15] 刘恒宇,马东宝,李林,等.双小钢板固定尺桡骨干骨折[J].中国矫形外科杂志,2023,31(1):81-83.