肱骨近端锁定钢板与髓内钉治疗老年肱骨近端二部分骨折疗效比较  

Comparison of Proximal Humeral Locking Plate and Intramedullary Nailing for Treating Proximal Humeral Fractures in Elderly

作　　者：毕红宾[1] 王永清[2] 李毅[2] 程鹏[2] 王业林[1] 赵志辉[2] 杨志强[2] 

机构地区：[1]天津中医药大学,天津300139 [2]天津医科大学第四中心临床学院

出　　处：《中国中医骨伤科杂志》2015年第12期34-37,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:比较锁定钢板和髓内钉治疗老年肱骨近端二部分骨折的疗效。方法:回顾性分析2011年6月至2013年6月60例肱骨近端二部分骨折患者。男性27例,女性33例;34例行锁定钢板固定,26例行髓内钉固定。比较两种方式的手术时间、出血量、骨折愈合时间、并发症和术后功能评分。结果:锁定钢板组患者手术时间(79.8±5.3)min,术中出血(300.0±10.6)mL,骨折愈合时间(13.1±2.5)周,末次随访Neer评分(87.5±3.6)分,ASES评分(91.2±4.0)分。髓内钉组患者手术时间(60.7±4.8)min,术中出血(180.0±13.5)mL,骨折愈合时间(12.5±3.6)周,末次随访Neer评分(85.9±4.5)分,ASES评分(89.7±3.4)分。手术时间、出血量比较差异有统计学意义(P<0.05);骨折愈合时间、Neer评分和ASES评分比较差异无统计学意义(P>0.05)。结论:锁定钢板和髓内钉治疗老年肱骨近端二部分骨折均能取得良好疗效。锁定钢板更适用于肱骨近端内侧较完整病例,髓内钉更适用于大结节无明显骨折患者,但两种方式均应重视内侧柱的有效复位和支撑。Objective：To compare the effect of locking proximal humeral plate and intramedullary nail for treating elderly patients with proximal humeral fractures. Methods： Retrospective analysis of 60 cases with locking proximal humeral plate （n= 34）or intramedullary nail（n= 26）for the treatment of proximal humeral fractures from June 2011 to June 2013 in our hospital,including 27 males and 33 females. The operation time, blood loss, bone healing time, complications and postoper- ative functional score were compared between the two groups. Results：In locking proximal humeral plate group, the opera tion time was（79.8±5.3）min,the blood loss was（300.0±10.6）mL,the bone healing time was（13. 1±2.5）weeks,the Neer score was（87.5±3.6）points,and the ASES score was（91.2±4.0）points at the final follow-up. In intramedullary nail group,the operation time was（60.7±4.8）min,the blood loss was（180.0±13.5）mL,the bone healing time was（12.5 ±3.6）weeks,the Neer score was（85.9＂1＂4.5）points,and the ASES score was（89.7±3.4） points at the final follow-up. There was significant difference in operation time and blood loss between the two groups（P〈0.05） ,but there was no sig- nificant differences in the bone healing time, Neer and ASES scores between the two groups（P〉 0.05）. Conclusion： The locking proximal humeral plate and intramedullary nail are both effective in the treatment of elderly with Neer two part of the proximal humeral fractures. The locking proximal humeral plate is more suitable for cases with inside complete of proximal humeral,while intramedullary proximal humeral nail is more suitable for patients with no fractures of the greater tuberosity. But it is significant to pay attention to the effective restoration and support of the medial column in both ways.

关 键 词：肱骨近端二部分骨折 锁定钢板 髓内钉 疗效 

分 类 号：R683.41[医药卫生—骨科学]