锁定钢板与髓内钉治疗老年肱骨近端二、三部分骨折疗效比较  

Locking plate and intramedullary nail in the treatment of elderly patients with proximal humerus of the two or three part fractures

作　　者：丁裕润[1] 王伟力[1] 马涛[1] 韦民[1] 李展春[1] 

机构地区：[1]上海交通大学医学院附属仁济医院骨科,上海200127

出　　处：《临床骨科杂志》2016年第1期75-78,共4页Journal of Clinical Orthopaedics

基　　金：国家自然科学基金(编号:81370976;81400904);上海市自然科学基金(编号:13ZR1424900);上海交通大学医工交叉基金(编号:YG2014MS41)

摘　　要：目的比较切开复位锁定钢板与有限切开复位髓内钉治疗老年肱骨近端骨折的临床疗效。方法手术治疗60例肱骨近端二、三部分骨折老年患者,行切开复位锁定钢板内固定术35例（钢板组）,行有限切开复位髓内钉内固定术25例（髓内钉组）。结果手术时间：钢板组70~100（87.6±8.4）min,髓内钉组60~100（79.6±10.8）min;术中出血量：钢板组100~200（149.4±26.5）ml,髓内钉组100~200（82.4±27.5）ml;住院天数：钢板组6~16（11.2±2.9）d,髓内钉组6~9（7.9±1.1）d;以上3项两组比较差异均有统计学意义（P〈0.05）。钢板组3例患者术后手术切口液化,经换药后愈合。患者均获得随访,时间6~24（12.0±3.0）个月。未出现内固定失败、肱骨头坏死等并发症。骨折愈合时间：钢板组2.5~4.0（3.4±0.8）个月,髓内钉组2.5~4.0（3.2±0.7）个月,两组差异无统计学意义（P〉0.05）。术后Neer肩关节功能总评分：钢板组67~84（74.6±5.0）分,髓内钉组70~86（77.8±3.8）分;功能：钢板组18~26（20.9±2.0）分,髓内钉组22~26（23.4±1.2）分;活动范围：钢板组12~22（16.7±2.6）分,髓内钉组14~22（17.9±2.1）分;以上3项两组比较差异有统计学意义（P〈0.05）。疼痛：钢板组25~30（29.9±0.8）分,髓内钉组25~30（29.8±1.0）分;解剖结构重建：钢板组4~8（7.2±1.5）分,髓内钉组4~8（6.6±1.4）分;以上2项两组比较差异均无统计学意义（P〉0.05）。结论髓内钉和锁定钢板内固定都是治疗老年患者肱骨近端骨折的有效手段,而髓内钉的创伤较小,住院时间较短,肩关节功能恢复更好。Objective To compare clinical effect between open reduction and internal fixation with locking plate and limited open reduction and intramedullary nail fixation for the treatment of elderly patients with proximal humeral fracture. Methods 60 cases of elderly patients with proximal humeral two or three part fractures were treated. 35 cases were treated by open reduction and locking plate internal fixation（ plate group） and the other 25 cases were treated by limited open reduction and intramedullary nail fixation（ nail group）. Results There was statistically significant difference between the plate group and the nail group with operation time which was 70 ~ 100（ 87. 6 ± 8. 4） min and60 ~ 100（ 79. 6 ± 10. 8） min,and the intraoperative blood loss which was 100 ~ 200（ 149. 4 ± 26. 5） ml and 100 ~200（ 82. 4 ± 27. 5） ml and the hospitalization time which were 6 ~ 16（ 11. 2 ± 2. 9） d and 6 ~ 9（ 7. 9 ± 1. 1） d（ P〈0. 05）. There were 3 cases of plate group with postoperative wound liquefaction and delayed union after wound care.All cases were followed up for 6 ~ 24（ 12. 0 ± 3. 0） months until fracture healing. No failure of internal fixation and humeral head necrosis had occurred. There was no significant difference between two groups with fracture healing time which were 2. 5 ~ 4. 0（ 3. 4 ± 0. 8） months and 2. 5 ~ 4. 0（ 3. 2 ± 0. 7） months（ P〈0. 05）. There was statistically significant difference between the two groups with Neer shoulder function scores after operation which were 67 ~ 84（ 74. 6 ± 5. 0） points and 70 ~ 86（ 77. 8 ± 3. 8） points and function scores which were 18 ~ 26（ 20. 9 ± 2. 0） points and 22 ~ 26（ 23. 4 ± 1. 2） points and activity range scores which were 12 ~ 22（ 16. 7 ± 2. 6） points and 14 ~ 22（ 17. 9 ± 2. 1） points（ P〈0. 05）. There was no significant difference between two groups with pain scores which were 25 ~ 30（ 29. 9 ± 0. 8） points and 25 ~ 30（ 29. 8 ± 1. 0） points and anatomical structure

关 键 词：肱骨近端骨折 锁定钢板 交锁髓内钉 Neer肩关节功能评分 

分 类 号：R683.41[医药卫生—骨科学] R687.3[医药卫生—外科学]