摘要
目的:比较Multiloc髓内钉内固定与锁定接骨板内固定治疗肱骨近端骨折的临床疗效和安全性。方法:回顾性分析58例肱骨近端骨折患者的病例资料,其中采用Multiloc髓内钉内固定治疗34例(髓内钉内固定组),采用锁定接骨板内固定治疗24例(接骨板内固定组)。比较2组患者的手术时间、术中出血量、住院时间、肩部疼痛视觉模拟量表(visualanaloguescale,VAS)评分、Constant-Murley肩关节评分及并发症发生率。结果:①一般指标。髓内钉内固定组患者的手术时间和住院时间均短于接骨板内固定组[(79.84±14.28)min,(108.74±22.17)min,t=6.726,P=0.003;(6.94±2.47)d,(12.78±3.18)d,t=9.732,P=0.000],髓内钉内固定组患者的术中出血量少于接骨板内固定组[(73.66±14.27)mL,(128.84±17.49)mL,t=8.783,P=0.000]。②肩部疼痛VAS评分。术前2组患者肩部疼痛VAS评分比较,差异无统计学意义[(8.85±1.43)分,(8.42±0.87)分,t=0.521,P=0.641];术后6个月,2组患者肩部疼痛VAS评分均低于术前(t=8.784,P=0.000;t=7.281,P=0.002),髓内钉内固定组患者肩部疼痛VAS评分低于接骨板内固定组[(3.24±0.43)分,(4.64±0.71)分,t=8.533,P=0.000]。③Constant-Murley肩关节评分。术前2组患者Constant-Murley肩关节评分比较,差异无统计学意义[(55.06±9.37)分,(54.44±9.27)分,t=0.974,P=0.558];术后6个月,2组患者Constant-Murley肩关节评分均高于术前(t=12.673,P=0.000;t=11.784,P=0.000),髓内钉内固定组患者Constant-Murley肩关节评分高于接骨板内固定组[(83.37±4.84)分,(71.64±5.37)分,t=0.308,P=0.013]。④并发症发生率。髓内钉内固定组1例发生肩峰撞击征,接骨板内固定组3例发生螺钉松动、2例发生肩峰撞击征;髓内钉内固定组患者的并发症发生率低于接骨板内固定组(χ^(2)=4.344,P=0.037)。结论:Multiloc髓内钉内固定治疗肱骨近端骨折,与锁定接骨板内固定相比,手术时间短、术中出血量少,能更好地缓解肩部疼痛、改善肩关节功能,且安全性高。
Objective:To compare the clinical curative effects and safety of internal fixation with Multiloc intramedullary nail(IMN)versus locking plate(LP)in treatment of proximal humeral fractures.Methods:The medical records of 58 patients with proximal humeral fractures were analyzed retrospectively.Thirty-four patients were treated with Multiloc IMN internal fixation(IMN internal fixation group),while the others with LP internal fixation(LP internal fixation group).The operative time, intraoperative blood loss, hospital stays, shoulder pain visual analogue scale(VAS)scores, Constant-Murley shoulder scores and complication incidence were compared between the 2 groups.Results:The operative time and hospital stays were shorter, and the intraoperative blood loss was less in IMN internal fixation group compared to LP internal fixation group(79.84±14.28 vs 108.74±22.17 minutes, t=6.726,P=0.003;6.94±2.47 vs 12.78±3.18 days, t=9.732,P=0.000;73.66±14.27 vs 128.84±17.49 mL,t=8.783,P=0.000).There was no statistical difference in shoulder pain VAS scores between the 2 groups before the surgery(8.85±1.43 vs 8.42±0.87 points, t=0.521,P=0.641).The shoulder pain VAS scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=8.784,P=0.000;t=7.281,P=0.002),and were lower in IMN internal fixation group compared to LP internal fixation group(3.24±0.43 vs 4.64±0.71 points, t=8.533,P=0.000).There was no statistical difference in Constant-Murley shoulder scores between the 2 groups before the surgery(55.06±9.37 vs 54.44±9.27 points, t=0.974,P=0.558).The Constant-Murley shoulder scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=12.673,P=0.000;t=11.784,P=0.000),and were higher in IMN internal fixation group compared to LP internal fixation group(83.37±4.84 vs 71.64±5.37 points, t=0.308,P=0.013).The acromion impingement syndrome was found in 1 patient in IMN internal fixation group and 2 patients in LP internal fixation group, moreover, screw loosening was found in 3 patients in LP internal fixation group.The postoperative complication incidence rate was lower in IMN internal fixation group compared to LP internal fixation group(χ^(2)=4.344,P=0.037).Conclusion:Multiloc IMN internal fixation has such advantages as shorter operative time and less intraoperative blood loss, and it can better relieve shoulder pain and improve shoulder function compared to LP internal fixation in treatment of proximal humeral fractures, and it exhibits high safety.
作者
金鹏宇
史景超
黄宁
张磊
JIN Pengyu;SHI Jingchao;HUANG Ning;ZHANG Lei(Medical and Health Group of Xiangshan Hospital of Traditional Chinese Medicine,Xiangshan 315700,Zhejiang,China)
出处
《中医正骨》
2021年第6期6-10,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
肩骨折
肱骨骨折
骨折固定术
内
髓内钉
锁定接骨板
临床试验
shoulder fractures
humeral fractures
fracture fixation,internal
intramedullary nail
locking plate
clinical trial
