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交锁髓内钉与钢板内固定治疗肱骨中、下段骨不连的比较
骨不连是肱骨中、下段骨折术后常见的并发症之一,发生率为15%~30%[1],治疗比较棘手.比较一致的治疗意见是切开复位、内固定并植骨,但究竟采用何种方式固定骨折存在争议.回顾2002年10月~2005年10月间分别采用钢板或髓内钉固定治疗的38例肱骨中、下段骨不连患者资料,分析如下.
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肱骨近端骨折手术治疗与保守治疗的比较
Summary Results from three randomized controlled trials (one of these is included with the caveat that it is an e-publication accessed ahead of the published version) were consistent with respect to treatment of three and four part fractures of the proximal humerus.All studies found no significant difference in functional outcomes;however, complications were significantly higher in the osteosynthesis treatment arm compared with the conservative arm in the two recent reports.Small sample size and subsequent lack of power to detect a difference between treatments was problematic in all studies.Larger,randomized studies are needed to further elucidate whether there is a difference between treatments in terms of functional outcome.对于肱骨近端三或四部分骨折的治疗,3项随机对照研究(其中1项研究以电子版发表)的结论一致.所有研究均发现,不论选择手术治疗还是保守治疗,患肢功能的恢复差异无统计学意义.但是现有的2项研究认为,与保守治疗相比,手术治疗会明显增加并发症的发生率.由于现有的研究均为小样本研究,缺乏足够的病例来说明两种治疗方法间的差异,因此,需通过开展大样本的随机对照研究来明确不同治疗方法对功能的恢复是否存在差异.
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肱骨远端骨折全肘关节成形术与切开复位内固定术的比较
概要根据一项小样本随机对照研究和一项小样本回顾性队列研究的结果,肱骨远端骨折时,与切开复位内固定术(ORIF)相比,全肘关节成形术(TEA)可有效改善肘关节的功能恢复.研究认为,采用TEA治疗的患者术后肘关节Mayo功能评分明显更优.另外,TEA治疗组术后患者自述的DASH评分、肘关节活动度、二次手术率也优于ORIF治疗组,尽管该差异无统计学意义.两种治疗方法术后并发症的发生率相似,但是对于异位骨化的发生率各研究结论不一.