JAMA Surg:闭合性肱骨干骨折治疗选择对长期功能预后的影响

2021-04-20 MedSci原创 MedSci原创

对于闭合性肱骨干骨折患者,治疗前医生应告知非手术功能性支撑治疗的风险,即三分之一的患者可能遇到骨折愈合问题而需要二次手术,2次手术患者的2年功能结果不佳。

肱骨干是指肱骨外科颈以下,肱骨髁以上的部位,此处骨折发生率较高,占全身骨折的1.93%-5.1%,占上肢骨折的6%-15%。对于闭合性移位肱骨干骨折患者,钢板固定手术治疗与非手术功能支撑治疗对患者预后的影响存在矛盾:有证据表明,对于闭合性肱骨干骨折患者,手术治疗后患者功能结果不优于非手术治疗,但也有统计发现多达三分之一的非手术治疗患者可能需要二次手术。

近日研究人员比较了二次手术人群vs初次治疗成功患者2年后功能预后的差异。

本次研究在芬兰开展,为期两年,包含82名成人闭合性移位肱骨干骨折患者,随机接受钢板固定手术(n=38;初始手术组)或功能支撑(n=44),功能支撑组中30人骨折成功愈合,而14因骨折愈合问题接受二次手术。研究的主要终点为2年时手臂、肩膀和手部的残疾(DASH)评分(范围为0到100分;0表示无残疾,100表示极度残疾;最小临床重要差异,10分)。

82名患者中,38例(46%)为女性,平均年龄为48.9(17.1)岁,共有74名患者(90%)完成了2年的随访。2年时,初始手术组的平均DASH评分为6.8,支撑成功组为6.0,而二次手术组为17.5。初始手术组和二次手术组之间的组间DASH评分差异为-10.7分,支撑成功组和二次手术组之间的DASH评分差异为-11.5分。

对于闭合性肱骨干骨折患者,治疗前医生应告知非手术功能性支撑治疗的风险,即三分之一的患者可能遇到骨折愈合问题而需要二次手术,2次手术患者的2年功能结果不佳。

原始出处:

Lasse Ramo et al. Outcomes With Surgery vs Functional Bracing for Patients With Closed, Displaced Humeral Shaft Fractures and the Need for Secondary Surgery A Prespecified Secondary Analysis of the FISH Randomized Clinical Trial.JAMA Surg. April 14, 2021.

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    2021-04-22 shalley68
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  7. [GetPortalCommentsPageByObjectIdResponse(id=1821578, encodeId=de5c18215e801, content=<a href='/topic/show?id=49c210165399' target=_blank style='color:#2F92EE;'>#骨干骨折#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101653, encryptionId=49c210165399, topicName=骨干骨折)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/72D57F5B3E12B2BB53D6BD015D14DCD6/100, createdBy=a92e2500162, createdName=passed water, createdTime=Wed Jun 09 05:41:05 CST 2021, time=2021-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2038245, encodeId=aeb820382455d, content=<a href='/topic/show?id=0b1f9e175d3' target=_blank style='color:#2F92EE;'>#闭合性肱骨干骨折#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97175, encryptionId=0b1f9e175d3, topicName=闭合性肱骨干骨折)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/017ED6AFEB45F49165298113DDC0656A/100, createdBy=84182500174, createdName=ms7019579240139182, createdTime=Mon May 03 14:41:05 CST 2021, time=2021-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1772743, encodeId=9e711e7274332, content=<a href='/topic/show?id=871064e139b' target=_blank style='color:#2F92EE;'>#治疗选择#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64713, encryptionId=871064e139b, topicName=治疗选择)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=015a38388258, createdName=liye789132264, createdTime=Wed Apr 21 00:41:05 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808526, encodeId=3a9218085265e, content=<a href='/topic/show?id=da658199174' target=_blank style='color:#2F92EE;'>#肱骨干#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81991, encryptionId=da658199174, topicName=肱骨干)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6595338, createdName=xuruicheng, createdTime=Sat May 29 01:41:05 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460648, encodeId=7d2014606482f, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Thu Apr 22 10:41:05 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492865, encodeId=ab5c149286582, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 22 10:41:05 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959219, encodeId=132895921942, content=对于闭合性肱骨干骨折患者,治疗前医生应告知非手术功能性支撑治疗的风险,即三分之一的患者可能遇到骨折愈合问题而需要二次手术,2次手术患者的2年功能结果不佳。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210420/a20b1f4b0b284f66978cacf34d4052dd/8eb1e274e6cb4b8faf3bd29bcd560227.jpg, createdBy=6f4d5483379, createdName=诗酒趁年华, createdTime=Wed Apr 21 23:18:50 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036580, encodeId=6ae61036580d8, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Apr 20 22:41:05 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-21 诗酒趁年华

    对于闭合性肱骨干骨折患者,治疗前医生应告知非手术功能性支撑治疗的风险,即三分之一的患者可能遇到骨折愈合问题而需要二次手术,2次手术患者的2年功能结果不佳。

    0

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    2021-04-20 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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