[1]杨良栋,张华泽,何举仁,等.锁定钢板与交锁髓内钉固定治疗老年Neer分型2、3部分肱骨近端骨折的疗效比较[J].中华老年骨科与康复电子杂志,2022,(02):96-103.[doi:10.3877/cma.j.issn.2096-0263.2022.02.005]
　Yang Liangdong,Zhang Huaze,He Juren,et al.Comparison of efficacy and safety of locking plate and interlocking intramedullary nail in the treatment of Neer type 2 and 3 partial humeral fractures in the elderly[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2022,(02):96-103.[doi:10.3877/cma.j.issn.2096-0263.2022.02.005]
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锁定钢板与交锁髓内钉固定治疗老年Neer分型2、3部分肱骨近端骨折的疗效比较()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2022年02期
页码:
96-103
栏目:
上肢
出版日期:
2022-04-05

文章信息/Info

Title:
Comparison of efficacy and safety of locking plate and interlocking intramedullary nail in the treatment of Neer type 2 and 3 partial humeral fractures in the elderly
作者:
杨良栋; 张华泽; 何举仁; 高艳刚; 李栋
054000 华北医疗健康集团邢台总医院创伤骨科
Author(s):
Yang Liangdong;  Zhang Huaze;  He Juren;  Gao Yangang;  Li Dong.
关键词:
肱骨近端骨折;  髓内钉;  锁定钢板;  疗效;  安全性
Keywords:
Humeral fracture;  Intramedullary nail;  Locking plate;  Efficacy;  Safety
DOI:
10.3877/cma.j.issn.2096-0263.2022.02.005
文献标志码:
A
摘要:
目的 对比锁定钢板与交锁髓内钉固定治疗Neer分型2、3部分肱骨近端骨折的疗效和安全性。方法 回顾性分析87例肱骨近端骨折临床资料，男性37例，女性52例，平均年龄（57.7±7.1）岁；锁定钢板组52例，髓内钉组37例；查阅患者病历资料、手术报告和随访资料，记录两组患者的手术切口、手术时间、术中出血、住院时间、骨折愈合所需时间，以及术后1、3、6和12个月随访时患者的肩关节功能、活动度和并发症。采用SPSS 25.0进行统计学描述和分析。结果 患者的随访时间为（14.1±3.6）个月（12～21个月）。在切口长度[（6.7±2.7）vs（11.6±3.8）cm，P=0.001]、手术时间[（104±37）vs（138±47）min，P=0.001]、失血量[（158±114）vs.（336±185）ml，P＜0.001）方面，髓内钉组显著优于锁定板固定组。髓内钉组较锁定板组具有更好的早期恢复优势[3个月时，ASES得分（69±7）分vs （59±9）分；Constant-Murley得分（62±8）分vs.（51±7）分；6个月时，ASES得分（84±6）分vs （72±9）分，Constant-Murley得分（76±7）分vs.（71±7）分，外旋（42±6）°vs（36±7）°]，差异均有统计学意义（P＜0.05）；在末次随访时，两组功能评分和活动度差异均无统计学意义。结论 髓内固定较锁定板固定在治疗肱骨近端2、3部分骨折时有更好的手术参数表现和早期功能恢复优势，对于有早期功能恢复特殊需求者可推荐髓内固定。
Abstract:
Objective To compare the efficacy of locking plate versus interlocking intramedullary nail in the treatment of Neer type 2 and 3 partial humeral fractures. Methods The clinical data of 89 cases of humeral fractures were retrospectively analyzed, including 52 cases in locking plate group and 37 cases in intramedullary nail group, 37 males and 52 females, with an average age of (57.7±7.1) years. 61% (50/82) of fractures were caused by falls.There was no statistically significant difference between the two groups in terms of demographics, comorbidities, and injury characteristics. The medical records, operative reports and follow-ups of the patients were reviewed. The surgical incision, operation time, intraoperative bleeding, hospital stay, time required for fracture healing, as well as the shoulder joint function, range of motion and complications during the follow-ups at 1, 3, 6 and 12 months postoperatively were recorded.Statistical description and analysis were performed using SPSS 25.0. Results Patients were followed up for (14.1±3.6) months (12 to 21 months). For surgical parameters, the intramedullary nail group performed significantly better than the locking plate fixation group, and the differences were statistically significant: incision length (6.7±2.7 cm vs. 11.6±3.8 cm, P=0.001), operation time (104±37 mins vs. 138±47 mins, P=0.001), and blood loss (158±114 ml vs 336±185 ml, P<0.001). Intramedullary nailing with locking plate group had significant advantage in early recovery [ASES score 69±7 vs. 59±9, Constant-Murley score 62±8 vs 51±7 at 3 months, ASES score 84±6 vs 72±9, Constant-Murley score 76±7 vs 71±7, external rotation (42±6)° vs (36°±7)° at 6 months], with all P<0.05, at last follow-up, there was no statistical difference in functional score and range of motion between the two groups. Conclusion Intramedullary fixation is superior to locking plate fixation in the treatment of 2 and 3 part humeral fractures in terms of surgical parameters and early functional recovery. Intramedullary fixation can be recommended for patients with particular needfor early functional recovery.

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备注/Memo

备注/Memo:
基金项目：邢台市科技计划项目（2020ZC340）
更新日期/Last Update: 2022-06-17