摘要
目的比较肱骨远端OTA/AO-C型开放性骨折与闭合性骨折切开复位内固定的疗效。方法回顾分析2014年1月至2017年6月就诊于北京积水潭医院创伤骨科的70例OTA/AO-C型肱骨远端骨折患者的临床资料。根据骨折类型将患者分为开放组22例(患者均为肱骨远端OTA/AO-C型GustiloⅠ、Ⅱ型开放性骨折)和闭合组48例(患者均为肱骨远端OTA/AO-C型闭合性骨折)。开放组男18例,女4例,年龄(42.6±13.0)岁;闭合组男21例,女27例,年龄(42.2±17.1)岁。分析患者受伤至手术时间、住院时间、受伤能量及功能预后。功能预后指标包括肘关节屈伸及旋转活动度、Mayo肘关节功能评分(MEPS)、上肢功能障碍评分(DASH)、并发症及二次手术发生率。结果开放组和闭合组患者年龄、损伤能量、受伤至手术时间等差异均无统计学意义(P>0.05),但开放组男性多于闭合组,差异有统计学意义(P=0.011)。所有患者术后随访时间平均34.0个月(25~54个月)。开放组和闭合组患者住院时间分别为9.5(6.0,13.0)d、8.5(6.0,11.0)d,屈伸活动度分别为120.0°(100.0°,137.8°)、128.5°(110.0°,140.0°),旋转活动分别为155.0°(151.3°,155.0°)、155.0°(155.0°,155.0°),MEPS评分分别为95.0(80.0,100.0)、95.0(80.0,100.0)分,DASH评分分别为2.6(0.63,9.2)、1.7(0.0,8.5)分,两组间比较差异均无统计学意义(P>0.05)。开放组和闭合组二次手术率[36.4%(8/22)vs.33.3%(16/48)]、尺神经症状[54.5%(12/22)vs.60.4%(29/48)]、内固定激惹[9.1%(2/22)vs.6.3%(3/48)]和肘关节僵硬发生率[13.6%(3/22)vs.10.4%(5/48)]差异均无统计学意义(P>0.05)。结论OTA/AO-C型肱骨远端开放性骨折(GustiloⅠ、Ⅱ型)行切开复位内固定能获得与闭合性肱骨远端骨折相近的临床效果,其术后活动度、功能评分以及并发症发生情况与闭合性骨折相比无显著差异。
Objective To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics,Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017.Of them,22 suffered from open fractures(Gustilo typesⅠ/Ⅱ)and 48 closed fractures.There were 18 males and 4 females with an age of(42.6±13.0)years in the open group and 21 males and 27 females with an age of(42.2±17.1)years in the closed group.Analyzed were interval from injury to surgery,hospitalization time,injury energy and functional outcomes which included range of motion(ROM)in elbow flexion and extension,ROM in elbow rotation,Mayo elbow performance score(MEPS),Disabilities of the Arm,Shoulder and Hand(DASH),complications and rate of secondary surgery.Results There was no significant difference between the 2 groups in age,injury energy or interval from injury to surgery(P>0.05),but there were significantly more males in the open group than in the closed group(P=0.011).The follow-up time for all the patients averaged 34.0 months(from 25 to 54 months).There were no statistically significant differences between the 2 groups in hospitalization time[9.5(6.0,13.0)d versus 8.5(6.0,11.0)d],ROM in flexion and extension[120.0°(100.0°,137.8°)versus 128.5°(110.0°,140.0°)],ROM in rotation[155.0°(151.3°,155.0°)versus 155.0°(155.0°,155.0°)],MEPS[95.0(80.0,100.0)versus 95.0(80.0,100.0)]or DASH[2.6(0.63,9.2)versus 1.7(0.0,8.5)](P>0.05).There were no statistically significant differences between the 2 groups either in rate of secondary surgery[36.4%(8/22)versus 33.3%(16/48)],ulnar nerve symptoms[54.5%(12/22)versus 60.4%(29/48)],local irritability in the region of internal fixation[9.1%(2/22)versus 6.3%(3/48)]or elbow stiffness[13.6%(3/22)versus 10.4%(5/48)](P>0.05).Conclusion Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open(Gustilo typesⅠ/Ⅱ)and closed distal humeral fractures of OTA/AO-C,with no significant differences in postoperative ROM,functional scores or complications.
作者
肖丹
陈辰
李庭
蒋协远
公茂琪
查晔军
孙伟桐
花克涵
Xiao Dan;Chen Chen;Li Ting;Jiang Xieyuan;Gong Maoqi;Zha Yejun;Sun Weitong;Hua Kehan(The Fourth Clinical College of Peking University,Beijing 100035,China;Department of Traumatology and Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2021年第5期422-427,共6页
Chinese Journal of Orthopaedic Trauma
基金
北京市自然科学基金-海淀原始创新联合基金(L192049)
北京市卫生健康委员会第三批公益性科研试点项目(京医研2019-9)
北京积水潭医院院内青年基金(QN-201925)。
关键词
肘关节
骨折
开放性
骨折
闭合性
骨折固定术
内
肱骨远端骨折
Elbow joint
Fractures,open
Fractures,closed
Fracture fixation,internal
Distal humeral fractures
