交锁髓内钉与锁定钢板治疗肱骨近端骨折的疗效研究

Treatment of humerus surgical neck fracture with interlocking intramedullary nail versus locking plate

目的探讨交锁髓内钉与锁定钢板治疗肱骨近端骨折的近期疗效。方法对2003年1月至2008年6月应用交锁髓内钉与锁定钢板治疗的36例肱骨近端骨折患者进行回顾性研究，男11例，女25例；年龄26～78岁，平均60．3岁。根据治疗方法不同分为交锁髓内钉组（21例）与锁定钢板组（15例）。按Neer分型：交锁髓内钉组：Ⅱ型6例，Ⅲ型13例，Ⅳ型2例；锁定钢板组：Ⅱ型4例，Ⅲ型8例，Ⅳ型3例。记录切口长度、手术时间、出血量，观察骨折愈合时间、功能恢复，并进行统计学分析。结果所有患者术后获6～24个月（平均15．3个月）随访，两组平均切口长度、手术时间、术中出血量比较差异有统计学意义（P〈0．05），两组骨折平均愈合时间比较差异无统计学意义（P〉0．05），肩关节功能恢复交锁髓内钉组优于锁定钢板组，比较差异无统计学意义（P〉0．05）。结论交锁髓内钉和锁定钢板治疗肱骨近端骨折均可获得较好效果，但交锁髓内钉固具有创伤小、操作简易的优点，是一种值得推广的治疗方法。

Objective To compare efficacy between the interlocking intramedullary nail and the locking plate in the treatment of humerus surgical neck fractures. Methods From January 2003 through June 2008, 36 patients with humerus surgical neck fracture were randomized into an interlocking intramedullary nail group （21 cases） and a locking plate group （15 cases）. They were 11 males and 25 females, with an average age of 60. 3 years （range, 26 to 78 years）. According to the Neer system, there were 6 cases of type Ⅱ, 13 cases of type Ⅲ and 2 cases of type Ⅳ in the nail group, while there were 4 cases of type Ⅱ, 8 cases of type m and 3 cases of type Ⅳ in the plate group. The data of wound length, operative time, intra-operative blood loss, fracture healing time and functional recovery were recorded and analyzed statistically. Results The follow-up periods ranged from 6 to 24 months （average, 15.3 months） . There were significant differences between the 2 groups（ P 〈 0. 05） in wound length, operative time and intra-operative blood loss, but the average fracture healing time was not significantly different between the groups（ P 〉 0.05） . The functional recovery was better in the intramedullary nail group than in the locking plate group but with no significance（ P 〉 0. 05）. Conclusion Although both theinterlocking intramedullary nail and the locking plate are similarly effective in the treatment of humerus surgical neck fractures, the former has an advantage in operative invasion and manipulative simplicity.