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《The Journal of Traditional Chinese Orthopedics and Traumatology》 2015-01
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A clinical comparison of closed reduction and elastic stable intramedullary nail internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents

CAO Jin;HU Shanshan;ZHENG Huajiang;YAO Lufeng;ZHONG Zhaoping;The 6th hospital of Ningbo city;  
Objective: To compare the clinical curative effect and safety of closed reduction and elastic stable intramedullary nail( ESIN) internal fixation versus open reduction and locking compression plate internal fixation for treatment of humeral shaft fractures in adolescents. Methods: The medical records of 57 adolescent patients with closed fracture of humeral shaft were analyzed retrospectively. The patients consisted of 36 males and 21 females,ranged in age from 14 to 18 years( Median = 16 yrs),and ranged in disease course from 2 to5 days( Median = 3 days). Closed reduction and ESIN internal fixation were performed in 28 patients( ESIN group) and open reduction and locking compression plate internal fixation were performed in 29 patients( locking compression plate group). Then the operative time,blood loss,hospital stay,fracture healing,limbs functional recovery and complications were recorded and compared between the 2 groups. Results:The surgery were performed successfully on 57 patients. ESIN group has shorter operation time and less intraoperative blood loss compared to locking compression plate group( 32. 1 + /- 5. 6 vs 103. 8 + /- 25. 2 min,t = 30. 770,P = 0. 000; 13. 9 + /- 3. 9 vs 171. 0 + /- 58. 2 ml,t =14. 246,P = 0. 000),while there was no statistical difference in the hospital stay between the 2 groups( 8. 8 + /- 1. 10 vs 9. 1 + /- 1. 3 days,t = 1. 006,P = 0. 319). The patients in the 2 groups were all followed up for 12- 36 months with a median of 25 months. All fractures united and fracture healing time was longer in ESIN group compared to locking compression plate group( 10. 7 + /- 2. 2 vs 9. 3 + /- 1. 9 weeks;t = 2. 440,P = 0. 018). According to Constant shoulder performance score,26 patients obtained an excellent result,1 good and 1 fair in the ESIN group; while 26 patients obtained an excellent result,2 good and 1 fair in the locking compression plate group; there was no statistical difference between the 2 groups( Z =- 0. 407,P = 0. 684). According to Mayo elbow performance score,25 patients obtained an excellent result,2 good and 1 fair in the ESIN group; while 25 patients obtained an excellent result,2 good and 2 fair in the locking compression plate group; there was no statistical difference between the 2 groups( Z =- 0. 378,P = 0. 705). No complications such as infection,breakage of internal fixators and fracture malunion were found in the 2 groups. One case of fracture delayed- union was found in ESIN group and the fracture united at 16 th week after the surgery without special treatment. Four cases of postoperative radial nerve injury were found in locking compression plate group,and the function of affected limb recovered after active functional exercises. One case of refracture was found after removing internal fixator,and the fracture united after open reduction and locking compression plate internal fixation. There was no statistical difference in complication rates between the 2 groups( chi( 2) = 0. 802,P = 0. 371). Conclusion: For treatment of humeral shaft fracture in adolescents,closed reduction internal fixation with ESIN and open reduction internal fixation with locking compression plate are similar to each other in limb function recovery,clinical curative effect and safety; however,the former has short operation time,less injury and long fracture healing time.
【CateGory Index】: R687.3
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