交锁髓内钉与锁定钢板内固定治疗Neer 2、3部分肱骨近端骨折疗效比较

目的比较肱骨近端锁定钢板与交锁髓内钉内固定治疗Neer 2、3部分肱骨近端骨折的疗效。方法回顾性分析自2012-01—2014-12诊治的128例Neer 2、3部分肱骨近端骨折,采用肱骨近端锁定钢板内固定治疗70例(锁定钢板组),采用交锁髓内钉内固定治疗58例(髓内钉组)。比较2组切口长度、手术时间、术中出血量、骨折愈合时间,以及术后12个月Constant-Murley肩关节功能评分及VAS评分。结果 128例均获得随访14~18个月,平均16.2个月。与锁定钢板组比较,髓内钉组手术时间更少,切口长度更短,术中出血量更少,差异有统计学意义(P0.05);但2组骨折愈合时间差异无统计学意义(P0.05)。术后12个月时,锁定钢板组与髓内钉组Constant-Murley评分、VAS评分差异无统计学意义(P0.05)。锁定钢板组并发症发生率为34.3%,髓内钉组并发症发生率为24.1%,但2组并发症发生率差异无统计学意义(P0.05)。结论交锁髓内钉和锁定钢板内固定治疗Neer 2、3部分肱骨近端骨折均可获得可靠疗效。在临床工作中,需综合考虑患者骨折情况、骨质疏松程度,以及术者手术操作熟练程度,合理选择内固定手术方案。

Comparison of interlocking intramedullary nail and locking plate in the treatment of proximal humeral 2-part and 3-part fractures

Objective To compare the results of interlocking intramedullary nail and locking plate in the treatment of proximal humeral 2-part and 3-part fractures.Methods Retrospective investigation and analysis were carried out in 128 patients with proximal humeral Neer 2-part and 3-part fractures treated with two different fixation methods:locking plate (locking plate group,70 cases) and interlocking intramedullary nail (nail group,58 cases) from January 2012 to December 2014.The average length of incisions,mean operation time,intraoperative blood loss,average healing time,the visual analogue scales (VAS) and Constant scores of injured shoulder joints at 12 months post operation were statistically compared.Results All 128 patients were followed up for 14-18 months,average 16.2 months.The mean operation time,average length of incisions and intraoperative blood loss in the nail group were less than those in the locking plate group.There were significant differences between the two groups (P ＜0.05).There was no significant difference in the average healing time between the two groups (P ＞0.05).At 12 months after operation,there were no significant differences in the VAS and Constant scores of injured shoulder joints between the two groups (P ＞0.05).The incidence rate of complications was 34.3％ in the locking plate group,and 24.1％ in the nail group.There was no significant difference in the complications rate between the two groups(P ＞0.05).Conclusion The interlocking intramedullary nail is as good as locking plate in internal fixation for Neer 2-part and 3-part proximal humeral fractures.In the clinical work,the surgeons may choose the best fit internal fixation method based on the fracture type,the degree of osteoporosis and own proficiency level.