长解剖钢板和髓内钉治疗肱骨近端骨折累及肱骨干骨折的疗效比较  

The effect comparison of proximal humeral fractures involving humeral shaft fractures treated with long anatomic plates versus locking intramedullary nails

作　　者：宋辉[1] 贺韬[1] 张超[1] 赵文博 李占玉[1] 韦民[1] 董宇启[1] SONG Hui, HE Tao, ZHANG Chao, ZHAO Wen-bo,LI Zhan-yu, WEI Min, DONG Yu-qi(Dept of Traumatic Orthopaedics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China)

机构地区：[1]上海交通大学医学院附属仁济医院创伤骨科,上海200120

出　　处：《临床骨科杂志》2018年第4期472-475,共4页Journal of Clinical Orthopaedics

基　　金：上海交通大学医学院多中心临床研究项目(编号:DLY201616)

摘　　要：目的比较长解剖钢板和髓内钉两种固定方式治疗肱骨近端骨折累及肱骨干骨折的疗效。方法将32例肱骨近端骨折累及肱骨干骨折患者根据治疗方法不同分为长解剖钢板组(14例)和髓内钉组(18例)。根据各项手术指标和随访时的肩关节功能评分评价治疗效果。结果患者均获得随访,时间9～20个月。切口长度、手术时间、术中出血量髓内钉组明显优于长解剖钢板组,差异均有统计学意义(P<0.05)。住院时间、骨折愈合时间、术后6个月颈干角两组比较差异均无统计学意义(P>0.05)。术后6个月,相对冈上肌力量长解剖钢板组优于髓内钉治疗组,差异有统计学意义(P<0.05);相对三角肌力量髓内钉组优于长解剖钢板组,但差异无统计学意义(P>0.05)。术后6个月,Constant-Murley评分、VAS评分、患侧肩关节活动度两组比较差异均无统计学意义(P>0.05)。结论长解剖钢板和髓内钉治疗肱骨近端骨折累及肱骨干骨折均能获得良好的预后,髓内钉具有手术微创等优点,但在相对冈上肌力量影响方面长解剖钢板优于髓内钉。Objective To compare the effect of the long anatomic plate and locking intramedullary nail in the treatment of proximal humeral fractures involving humeral shaft fractures. Methods Thirty-two patients who were diagnosed with proximal humeral fractures involving humeral shaft fractures were treated with either long anatomic plates（ 14 cases） or locking intramedullary nails（ 18 cases）. The operative related data and the follow-up data of shoulder joint function score were analyzed to assess the prognosis effect of these two different fixation methods. Results All the patients were followed up for 9 ～ 20 months. The locking intramedullary nail were significantly superior with regard to the length of incision,operative time,and blood loss during operation when compared with the long anatomic plate（ P 0. 05）. There were no differences in the length of hospitalization,bone union time and the final neck-shaft angle（ 6 months after operation）（ P 0. 05）. At 6 months after operation,for the average strength of the supraspinatus,the long anatomic plate was better and there was significant difference（ P 0. 05）; for the average strength of the deltoid muscle,the locking intramedullary nail was better,but there was no significant difference（ P 0. 05）. At 6 months after operation,there were no significant differences in the Constant-Murley scores,VAS and the activity range of shoulder joint between two groups（ P 0. 05）. Conclusions For proximal humeral fractures involving humeral shaft fractures,both the long anatomic plate and the locking intramedullary nail fixation methods can achieve satisfactory results. The locking intramedullary nail is minimally invasive,while the long anatomic plate is superior in the the average strength of the supraspinatus.

关 键 词：肱骨近端骨折 肱骨干骨折 长解剖钢板 髓内钉 

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