锁定型髓内针和锁定型钢板治疗肱骨近端骨折的对比研究

目的 对比肱骨近端锁定型髓内针或肱骨近端锁定型钢板治疗肱骨近端骨折的疗效,并探究两种内固定物各自的特点. 方法 54例新鲜肱骨近端二部分外科颈骨折患者,分为髓内针同定组(26例)和锁定犁钢板同定组(28例),两组在平均年龄比例、性别比例、优势侧受累比例方面差异尤统计学意义.最终随访时进行洋细肩关节体检,拍摄肩关节X线片以评价愈合的情况,并应用疼痛的视觉评分(VAS),美国肩肘外科医师评分(ASES),Constant-Murley评分,以及简单肩关节功能问卷(SST)评估患者肩关节功能,对比两组的结果. 结果 所有骨折均在术后8周内初步愈合.随访过程中两组均未出现感染、肱骨头坏死.钢板组患者并发症率较髓内针组高.两组的肩关节功能恢复情况均比较令人满意.两组间在术后患肢平均主动前屈上举、主动体侧外旋、主动内旋体侧内旋活动度、Constant-Murley评分、SST评分方面差异无统计学意义.但钢板组在最终患者的肩关节ASES评分、VAS评分和平均冈上肌肌力等方而优于髓内针组. 结论 两种内固定物均可较满意地治疗肱骨近端二部分外科颈骨折.锁定型髓内针创伤较小,而锁定型钢板在术后功能恢复方面更具优势.

Locking intrameduilar nail and locking plate in treatment of proximal humerus fractures:a comparative study

Objective To compare the results of locking intramedullar nail and Locking plate in treating proximal humerus fractures and discuss features of each instrument. Methods A total of 54 patients with fresh two-part surgical neck fracture of proximal humerus were divided into intramedullar nail fixation group(26 patients)and locking plate fixation group(128 patients).with no statistical difference upon age,gender and dominate hand involvement in two groups.At final follow-up,physical examination and X-ray films were used to evaluate fracture healing of shoulder ioint.In the meantime,VAS score,ASES score,Constant-Murley score,UCLA and SST questionnaire were used to evaluate the function of the shoulder in two groups. Results All fractures were healed basically within 8 weeks postoperative-ly.No infection or av&scular necrosis were fouml during follow-up.The incidence rate of complication in locking plate fixation group was higher than that in intramedullar nail fixation group.Both groups obtained satisfactory functional recovery of shoulder ioint.There was no statistieal difference in regard to active for-ward elevation,external rotation besides body,active height of internal rotation,Constant-Murley scores,and SST scores in both groups.The average ASES score and VAS score of locking plate fixation group was significantly better than those of intramedullar nail fixation group. Conclusions Both fixations can treat surgical neck fractures of proximal humerus well.Locking intramedullar nail causes less trauma to the patient while Locking plate has advantages in patients'final functional recovery.