摘要
目的 探讨闭合复位Trigen髓内钉内固定治疗Neer 2~4型肱骨近端骨折的临床疗效。方法 回顾性分析2018年2月—2021年4月南阳市中心医院骨科收治的103例Neer 2~4型肱骨近端骨折患者的病例资料,其中男性65例,女性38例;年龄40~75岁,平均57.1岁;摔伤64例,道路交通伤39例。根据手术方式不同分为钢板组(采用切开复位钢板内固定治疗,48例)和髓内钉组(采用闭合复位Trigen髓内钉内固定治疗,55例)。比较两组围术期指标、疼痛评分、肩关节功能、骨折愈合时间、肱骨颈干角、血清应激因子及并发症发生率。结果 髓内钉组手术时间[(50.66±6.14)min vs.(71.68±8.89)min]、术中出血量[(63.46±11.52)mL vs.(137.45±15.63)mL]、切口长度[(3.52±0.76)cm vs.(14.56±1.13)cm]、术后引流量[(14.87±2.73)mL vs.(79.48±11.25)mL]、骨折愈合时间[(8.34±1.02)周vs.(10.76±1.15)周]少于钢板组(P<0.05)。髓内钉组术后1个月[(2.83±0.54)分vs.(4.52±0.76)分]、6个月[(1.14±0.21)分vs.(1.76±0.35)分]的视觉模拟评分均低于钢板组(P<0.05)。髓内钉组术后6个月[(79.59±6.37)分vs.(66.42±7.36)分、(77.48±5.37)分vs.(61.48±6.24)分]、1年[(89.63±5.58)分vs.(79.69±6.84)分、(88.74±5.26)分vs.(80.36±6.79)分]的美国肩肘外科医师协会评分、Constant-Murley评分均显著高于钢板组(P<0.05)。术后1d[(23.48±2.92)mg/L vs.(28.67±3.36)mg/L、(475.24±21.76)nmol/L vs.(542.67±25.44)nmol/L]髓内钉组血清促肾上腺皮质激素、皮质醇水平均低于钢板组(P<0.05)。髓内钉组并发症发生率(3.64%)低于钢板组(16.67%,P<0.05)。结论 与切开复位钢板内固定相比,闭合复位Trigen髓内钉内固定治疗Neer 2~4型肱骨近端骨折造成的创伤更小、疼痛更轻,更利于术后恢复,且并发症发生率更低。
Objective To explore the clinical effect of closed reduction Trigen intramedullary nailing in the treatment of Neer type 2-4 proximal humeral fractures.Methods Clinical data of 103 patients with Neer type 2-4 proximal humeral fractures who were admitted to our hospital from Feb.2018 to Apr.2021 were retrospectively analyzed,including 65 males and 38 females aged 40-75 years,mean 57.1 years.The injury causes were falls in 64 cases and road traffic accidents in 39 cases.According to the surgical approaches,patients were divided into steel plate group(open reduction+steel plate internal fixation,n=48)and intramedullary nailing group(closed reduction+Trigen intramedullary nailing,n=55).The perioperative indexes,visual analogue scale(VAS),shoulder function,fracture healing time,recovery of humeral neck-shaft angle,serum stress factors and complications were compared between the two groups.Results Compared with the steel plate group,the intramedullary nailing group showed much less operation time(min,50.66±6.14 vs.71.68±8.89)and intraoperative blood loss(mL,63.46±11.52 vs.137.45±15.63),shorter incision length(cm,3.52±0.76 vs.14.56±1.13),less postoperative drainage(mL,14.87±2.73 vs.79.48±11.25)and quicker fracture healing(weeks,8.34±1.02 vs.10.76±1.15),all revealing significant difference(all P<0.05).The VAS was also much lower than that of the steel plate group at 1 month(2.83±0.54 vs.4.52±0.76)and 6 months after surgery(1.14±0.21 vs.1.76±0.35,both P<0.05).Moreover,the American Society of Shoulder and Elbow Surgeons(ASES)score and Constant-Murley score were significantly higher at 6 months(79.59±6.37 vs.66.42±7.36,77.48±5.37 vs.61.48±6.24)and 1 year after surgery(89.63±5.58 vs.79.69±6.84,88.74±5.26 vs.80.36±6.79,both P<0.05).As for the stress factors,the intramedullary nailing group showed much lower levels of serum adrenal corticotropic hormone(mg/L,23.48±2.92 vs.28.67±3.36)and cortisol(nmol/L,475.24±21.76 vs.542.67±25.44)at 1 day after surgery(both P<0.05).The incidence of complications was also lower in intramedullary nail group(3.64%)than in steel plate group(16.67%,P<0.05).Conclusion Compared to conventional open reduction and steel plate internal fixation,closed reduction Trigen intramedullary nailing in the treatment of Neer type 2-4 proximal humeral fractures presents less invasion and pain,and is more conducive to postoperative recovery and prevention of complications.
作者
刘瑜
张长成
王峰
孙子路
Liu Yu;Zhang Changcheng;Wang Feng;Sun Zilu(Department of Orthopaedics,Nanyang Central Hospital,Nanyang,Henan 473000,China)
出处
《创伤外科杂志》
2023年第11期830-837,共8页
Journal of Traumatic Surgery
基金
河南省医学科技攻关计划联合共建项目(LHG20201300)。
关键词
肱骨近端骨折
闭合复位
髓内钉
内固定
疗效
Proximal humeral fractures
Closed reduction
Intramedullary nailing
Internal fixation
Clinical efficacy
