髓内钉微创治疗老年Neer 2部分肱骨近端骨折的前瞻性临床研究  

Minimally invasive treatment of senile Neer two-part proximal humeral fractures with intramedullary nail:a prospective clinical research

作　　者：陈泽权 罗小辑[2] 李飞龙 王洪林 CHEN Zequan;LUO Xiaoji;LI Feilong;WANG Honglin(Wushan Hospital of Traditional Chinese Medicine,Chongqing 404799,China;The First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Dazu District People′s Hospital,Chongqing 402360,China)

机构地区：[1]重庆市巫山县中医院,重庆404799 [2]重庆医科大学附属第一医院,重庆400042 [3]重庆市大足区人民医院,重庆402360

出　　处：《现代医药卫生》2023年第16期2756-2760,共5页Journal of Modern Medicine & Health

基　　金：重庆市科卫联合医学科研项目(2019NXM016)。

摘　　要：目的探讨髓内钉微创手术治疗老年Neer 2部分肱骨近端骨折(PHF)的近远期临床疗效。方法前瞻性研究分析2017年1月至2020年1月重庆市巫山县中医院、重庆医科大学附属第一医院和重庆市大足区人民医院骨科收治的86例60岁及以上老年Neer 2部分PHF患者的临床资料。将患者随机分为髓内钉微创手术组(观察组)和非手术组(对照组),各43例。主要观察指标为2年随访期间手臂、肩膀和手的残疾[上肢功能障碍评定量表(DASH)]评分。次要观察指标包括肩关节功能评分[肩关节功能评分(CMS)和牛津肩关节评分问卷(OSS)评分]、疼痛评分[疼痛视觉模拟量表(VAS)]和骨代谢指标。结果治疗前,2组患者DASH评分、OSS评分、CMS及VAS评分比较,差异均无统计学意义(P>0.05)。治疗后3、6个月,观察组患者DASH评分低于对照组,OSS评分、CMS均高于对照组,差异均有统计学意义(P<0.05);治疗后12、24个月,2组患者DASH、OSS评分及CMS比较,差异均无统计学意义(P>0.05)。治疗后3、6个月,观察组患者VAS评分均低于对照组,差异均有统计学意义(P<0.05);治疗后12个月,2组患者VAS评分比较,差异无统计学意义(P>0.05)。治疗后12个月,观察组患者骨代谢指标均高于对照组,差异均有统计学意义(P<0.05);治疗后24个月,2组患者骨代谢相关指标比较,差异均无统计学意义(P>0.05)。结论对于60岁及以上的老年Neer 2部分PHF患者,手术治疗和非手术治疗2年后的临床结果相仿。Objective To investigate the short-term and long-term clinical efficacy of minimally invasive intramedullary nail in the treatment of senile Neer two-part of proximal humeral fractures(PHF).Methods A prospective study was conducted to analyze the clinical data of 86 senile Neer 2-part PHF patients aged 60 and above who were admitted to the Department of Orthopaedics of Wushan Hospital of Traditional Chinese Medicine,the First Affiliated Hospital of Chongqing Medical University and Dazu District People′s Hospital of Chongqing from January 2017 to January 2020.All patients were randomly divided into the intramedullary nail minimally invasive operation group(observation group)and the non-surgical group(control group).with 43 cases in each group.The main outcome measure were arm,shoulder,and hand disability[Upper Limb Dysfunction Rating Scale(DASH)]scores during 2-year follow-up.The secondary measures included shoulder function score[Shoulder Function Score(CMS)and Oxford Shoulder Questionnaire(OSS)score],pain score[Visual Analogue Scale for Pain(VAS)]and bone metabolism index.Results Before treatment,there were no significant differences in DASH score,OSS score,CMS and VAS score between the two groups.(P>0.05).After three and six months of treatment,DASH score of the observation group was lower than the control group,OSS score and CMS were higher than the control group,the differences were statistically significant(P<0.05).After 12 and 24 months of treatment,there were no significant differences in DASH,OSS and CMS score between the two groups(P>0.05).After three and six months of treatment,the VAS scores of patients in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).After 12 months of treatment,there was no statistical difference in VAS scores between the two groups(P>0.05).After 12 months of treatment,the indexes of bone metabolism in the observation group were higher than those in the control group,the difference was statistically signi

关 键 词：肱骨近端骨折 髓内钉 微创手术 老年人 前瞻性研究 

分 类 号：R459.9[医药卫生—治疗学]