髓内钉固定老年肱骨近端骨折是否重建内侧柱  

Intramedullary nail fixation of proximal humerus fractures with or without medial column supporting reconstruction in elderly

作　　者：马智强 王华松 李奕博 黄继锋 MA Zhi-qiang;WANG Hua-song;LI Yi-bo;HUANG Ji-feng(Department of Orthopaedics,General Hospital,Central Theater of PLA,Wuhan 420000,China)

机构地区：[1]中部战区总医院骨科,湖北武汉420000

出　　处：《中国矫形外科杂志》2024年第20期1839-1845,共7页Orthopedic Journal of China

摘　　要：[目的]比较Multiloc髓内钉内固定治疗老年肱骨近端骨折(proximal humerus fractures.PHF)是否内侧柱支撑重建的疗效。[方法]回顾性分析本院2020年1月—2022年8月收治的84例老年PHF患者的临床资料。根据医患沟通结果,44例行内侧柱支撑重建联合Multiloc髓内钉治疗(重建组),另外40例行单纯Multiloc髓内钉内固定(未重建组)。比较两组围手术期、随访及影像学指标。[结果]重建组手术时间[(90.7±9.0)min vs(85.0±8.5)min,P=0.004]显著长于未重建组,但前者的主动活动时间[(5.5±1.3)d vs(6.4±1.5)d,P=0.004]、住院时间[(7.5±1.4)d vs(8.6±2.0)d,P=0.004]显著少于后者。两组切口总长度、术中失血量、术后引流量及切口愈合等级的差异均无统计学意义(P>0.05)。随访时间平均(16.0±2.5)个月,重建组完全负重时间显著早于未重建组[(82.6±9.8)d vs(115.0±17.4)d,P<0.001]。随时间推移,两组VAS、ASES、Constant-Murley评分及前屈上举、外展上举ROM均显著改善(P<0.05)。相应时间点,重建组VAS、ASES、Constant-Murley评分均显著优于未重建组(P<0.05)。此外,术后3个月重建组前屈上举及外展上举ROM显著优于未重建组(P<0.05),但术后12个月两组ROM的差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量、骨折愈合时间、术后即刻及末次随访时肱骨颈-干角(humeral neckshaftangle,HNSA)的差异均无统计学意义(P>0.05)。[结论]内侧柱支撑重建联合Multiloc髓内钉内固定治疗老年PHF安全有效,有利于功能恢复,改善肩关节活动度。[Objective]To compare the clinical efficacy of Multiloc intramedullary nail fixation of proximal humerus fractures(PHF)with or without medial column supporting reconstruction in the elderly.[Methods]A retrospective study was done on 84 elderly patientswho receive Multiloc intramedullary nail fixation for PHF in our hospital from January 2020 to August 2022.According to doctor-patientcommunication,44 patients underwent the fixation with medial column supporting reconstruction(the reconstruction group),while the other40 patients underwent Multiloc intramedullary nail fixation alone(the non-reconstruction group).The perioperative period,follow-up andimaging parameters were compared between the two groups.[Results]Although the reconstruction group consumed significantly longer operative time than the non-reconstruction group[(90.7±9.0)min vs(85.0±8.5)min,P=0.004],the former was significantly superior to the latter in terms of time to regain initiative activity[(5.5±1.3)days vs(6.4±1.5)days,P=0.004]and the hospital stay[(7.5±1.4)days vs(8.6±2.0)days,P=0.004].There were no significant differences in the total incision length,intraoperative blood loss,postoperative drainage volumeand incision healing grade between the two groups(P>0.05).The mean follow-up time was of(16.0±2.5)months,while the reconstructiongroup resumed full weight-bearing activities significantly earlier than the non-reconstructed group[(82.6±9.8)days vs(115.0±17.4)days,P<0.001].The VAS,ASES,Constant-Murley scores were significantly improved in both groups over time(P<0.05),in which the reconstruction group was significantly better than the non-reconstruction group at all time point accordingly(P<0.05).In addition,the reconstructiongroup was also significantly better than the non-reconstruction group in forward flexion uplifting and abduction uplifting range of motions(ROMs)at 3 months after surgery(P<0.05),but which became not significant different between the two groups at 12 months after surgery(P>0.05).Regarding imaging,there were no signi

关 键 词：老年 肱骨近端骨折 内侧柱支撑重建 Multiloc髓内钉 开放复位内固定 

分 类 号：R683.41[医药卫生—骨科学]