肱骨近端锁定钢板与髓内钉内固定治疗Neer 3部分肱骨近端骨折的比较  

Comparison of proximal humeral locking plate and intramedullary interlocking nail for treatment of Neer 3-part proximal humeral fractures

作　　者：周欣[1] 韦民[1] 王伟[1] 张超[1] 董宇启[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：《中国骨与关节损伤杂志》2018年第1期28-31,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较肱骨近端锁定钢板与髓内钉内固定治疗Neer 3部分肱骨近端骨折的临床疗效。方法回顾性分析自2010-09—2016-05诊治的127例Neer 3部分肱骨近端骨折,采用肱骨近端锁定钢板内固定治疗64例(锁定钢板组),采用肱骨近端髓内钉内固定治疗63例(髓内钉组)。比较2组手术时间、术中出血量、术中透视次数、住院时间、骨折愈合时间,以及术后6、12个月肩关节功能Neer评分及ASES评分。结果髓内钉组在手术时间、术中出血量、住院时间方面优于锁定钢板组,差异有统计学意义(P<0.05);2组术中透视次数、骨折愈合时间比较差异无统计学意义(P>0.05)。127例均获得随访,随访时间平均14.1(13~16)个月。末次随访时X线片显示所有骨折均达到骨性愈合。髓内钉组术后6个月肩关节功能Neer评分、ASES评分优于锁定钢板组,差异有统计学意义(P<0.05);术后12个月时,2组肩关节功能Neer评分、ASES评分差异无统计学意义(P>0.05)。结论肱骨近端锁定钢板与髓内钉内固定治疗Neer 3部分肱骨近端骨折均可取得满意的临床疗效,但髓内钉内固定创伤更小,术后肩关节功能恢复更快。Objective To compare the effect of proximal humeral locking plate and intramedullary interlocking nail for treatment of Neer 3-part proximal humeral fractures. Methods Between September 2010 and May 2016, 127 patients with Neer 3-part proximal humeral fractures were reviewed. Sixty four patients were treated with proximal locking plate, 63 patients were treated with intramedullary nailing system. The operation time, perioperative blood loss, intraoperative perspective frequency, hospitalization time, bone union time, and 6 and 12 months after surgery, the Neer score and the ASES score were recorded and compared. Results The intramedullary nailing system group were better than the proximal humeral locking plate group in operation time, perioperative blood loss, hospitalization time, there were significant differences （P 〈0.05）. There were no statistically significant differences in the intraoperative perspective frequency and the bone union time （P 〉0.05）. All 127 patients were followed up with an average of 14.1 （13-16）months. At the last time of follow-up, X-ray showed that all fractures were healed. Six months postoperatively, the Neer scoring system and ASES in intramedullary nailing system group were better than those in proximal humeral locking plate group, there were significant difference （P 〈0.05）. Twelve months postoperatively, there were no statistically significant differences in Neer scoring system and ASES between the two groups（P 〉 0.05）. Conclusion Proximal humeral locking plate and intramedullary interlocking nail can achieve the same clinical outcomes for treatment of the Neer 3-part proximal humeral fractures, but the intramedullary interlocking nail is less invasive, and it is more advantageous than the shoulder joint function recovery.

关 键 词：NEER 3部分肱骨近端骨折 肱骨近端锁定钢板 肱骨近端髓内钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]