摘要
目的 对比分析Multiloc髓内钉与Philos锁定钢板治疗肱骨近端骨折的临床疗效.方法 回顾性分析2015年1月-2016年6月北京市海淀医院骨科以及首都医科大学附属北京朝阳医院骨科收治的34例肱骨近端骨折患者的病例资料,排除3例高能量损伤合并多处骨折患者,排除1例人工肱骨头置换术患者及1例非手术治疗患者.最终纳入29例患者,均获得门诊随访至术后12个月.按手术方式不同分为切开复位Philos锁定钢板内固定组13例(锁定钢板组)及闭合复位Muhioc髓内钉内固定组16例(髓内钉组),比较两组患者的手术时间、术中出血量、术前至术后24h血红蛋白变化、术后24 h视觉模拟评分及术后3、6、12个月Constant-Murley肩关节功能评分.应用SPSS13.0统计学软件对两组数据进行分析,计量资料采用均数±标准差((x)±s),组间比较采用独立样本t检验,重复测量资料采用重复测量方差分析.结果 锁定钢板组年龄为(65.7±9.3)岁,髓内钉组年龄为(65.6 ±11.1)岁.锁定钢板组手术时间为(150 ±17) min,术中出血量为(300±53) ml,术前至术后24 h血红蛋白变化为(26 ±8) g/L,术后24 h视觉横拟评分为(3.4±0.8)分.髓内钉组手术时间为(119±13) min,术中出血量为(130±25) ml,术前至术后24h血红蛋白变化为(11 ±5) g/L,术后24h视觉模拟评分为(2.3±0.5)分.两组病例均未见发生严重术后并发症,包括感染、内固定失效、骨折不愈合及肱骨头坏死等.术后Constant-Murley肩关节功能评分方面,锁定钢板组术后3个月为(76.0±11.6)分,术后6个月为(78.0±13.4)分,术后12个月为(88.0±12.1)分,髓内钉组术后3个月为(85.0±9.7)分,术后6个月为(87.0±8.9)分,术后12个月为(89.0±10.3)分.两组病例在术后严重并发症发生率、术后12个月Constant-Murley肩关节功能评分差异无统计学意义(P＞0.05).Mltiloc髓内钉组手术时间、手术出血、术后视觉模拟评分、术后3个月及6个月Constant-Murley评分优于锁定钢板组.结论 Multilock髓内钉是治疗肱骨近端骨折的有效方式,熟练掌握后,相比锁定钢板具有手术创伤小、术后早期疗效满意等优点.
Objective To compare the clinical effect of Multiloc nailing and Philos locking plate for treating proximal humerus fracture.Methods A retrospective analysis of 34 surgery treated proximal humeral fractures patients in Department of Orthopedics,Beijing Haidian Hospital and Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University from January 2015 to June 2016,in which 3 cases of high-energy injury and multiple fractures andonecase of humerus head replacement and onecase of non-surgical treatment were excluded.Finally,29 patients were included and clinical followed up to 12 months after surgery.The 29 paients were divided into the locking plate group (n =13) and intramedullary nail group (n =16),The operative time,volume of intraoperative blood loss,preoperative to postoperative 24 patients were compared between the locking plate group and intramedullary nail group underwent open reduction and internal fixation with philos locking plate hemoglobin changes,24 h postoperative visual analogue scale and 3,6,12 months postoperative Constant-Murley shoulder function score.SPSS13.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ± s).Comparison of groups used independent samples t test,repeated measurement data used repeated measures analysis of variance.Results The age of the locking plate group was (65.7 ± 9.3) years,and the age of the intramedullary nailing group was (65.6 ± 11.1) years.In the locking plate group,the operation time was (150 ± 17) minutes,the intraoperative blood volume was (300 ± 53) ml,the change of blood pigment between before surgery to 24 hours after surgery was (26 ± 8) mg/L,and the vision algetic standard of 24 hours after surgery was (3.4 ± 0.8) scores.In intramedullary nailing group,the operation time was (119 ± 13) minutes,the intraoperative blood volume was (130 ± 25) ml,and the change of blood pigment between before surgery to 24 hours after surgery was (11 ± 5) g/L,the vision algetic standard of 24 hours after surgery was (2.3 ± 0.5) scores.No serious postoperative complications occurred in either group,including infection,internal fixationfailure,and humeral head necrosis.In locking plate group,for the Constant-Murley shoulder joint function score,3 months after surgery was (76.0 ± 11.6) scores,6 months was (78.0 ± 13.4) scores,12 months was (88.0 ± 12.1) score.In intramedullary nailing group 3 months was (85.0 ± 9.7) scores,6 months was (87.0 ± 8.9) scores,12 months was (89.0 ± 10.3) scores.There were no statistical difference between the two groups at incidence of serious complications after surgery,postoperative 12 months Constant-Murley shoulder joint function score.Muhiloc intramedullary nailing group was better than Philos locking plate group in the operation time,the intraoperative blood volume,etc.Conclusion Multiloc intramedullary nail is an effective method for treating proximal humerus fracture,and it has the advantages of less surgical injury and early postoperativesatisfactory than the locking plate.
出处
《国际外科学杂志》
2018年第3期168-172,共5页
International Journal of Surgery
关键词
肱骨骨折
骨折固定术
内
对比研究
Humeral fractures
Fracture fixation,internal
Comparative study
