Multiloc髓内钉治疗肱骨近端骨折的近期疗效

Short-term clinical outcome of proximal humeral fractures using Multiloc proximal humeral nail

目的评估Muhiloc髓内钉治疗肱骨近端骨折的近期疗效。方法2014年2至9月Neer分型两部分以上采用Multiloc肱骨近端髓内钉治疗并获得3个月以上随访的15例肱骨近端骨折患者的病历资料纳入研究，男4例，女11例；年龄58-73岁，平均63．7岁，随访时间3-10个月，平均5．2个月。Neer两部分骨折8例（53．3％，8／15）、三部分7例（46．7％，7／15），所有骨折均为闭合性骨折。记录手术时间、出血量，术后1、3、6、12个月门诊定期复查并记录患者肩关节功能、X线片检查复位效果及愈合情况、美国肩肘外科协会评分（rating scale of the American Shoulder and Elbow Surgeons，ASES）、Constant评分及视觉模拟评分（visual analogue scale，VAS）评分以及并发症等指标，并将不同骨折类型的各指标进行比较。结果15例患者均顺利完成手术，手术时间70-200min，平均145．3min；术中出血量50-310ml，平均189．3ml。至末次随访，VAS评分0-3分，平均1．7分；ASES评分73-100分，平均83．1分；Constant评分71-91．5分，平均81．7分；肩关节前屈上举120°-165°，平均136．7°；体侧外旋25°-40°，平均30．3°；外展外旋20°-35°，平均26．2°。Neer两部分骨折组与三部分骨折组相比，差异均无统计学意义。5例未使用4mm Calcar螺钉者，Constant评分87（85，92）分、ASES评分90（83．5，100）分，高于其余10例使用Calcar螺钉者[Constant评分83（77，90）分、ASES评分85（73，95）分]。7例使用了一枚钉中钉者，Constant评分为88（78，92）分、ASES评分91．5（75，100）分，高于使用两枚以上钉中钉的8例患者[Constant评分80．5（74，88．5）分、ASES评分81．8（73，92．5）分]。1例患者出现肘关节僵硬，并发症发生率为6．7％。结论Muhiloc髓内钉治疗肱骨近端骨折短期疗效优良，手术时间短、切口小、软组织损伤少、血供破坏少、并发症少，近期疗效较好；患者既往肩痛史、合并肩袖损伤等情况对预后有负面影响。

Objective To evaluate the short-term functional outcome of Multiloc Proximal Humeral Nails （PHN） in the treatment of proximal humeral fractures, by retrospectively reviewing the function and complications of our institutional experience. Methods 15 patients were treated operatively for displaced proximal humeral fractures using the Multiloc PHN. Fractures were classified according to Neer＇s classification. Male 4 cases, female 11 cases, with a mean age 63.7 years （58-73 years）, and the mean follow-up was 5.2 months （3-10 months）. A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the rating scale of the American Shoulder and Elbow Surgeons （ASES） and Constant Score, Visual Analogue Scale （VAS） scores. Results 15 patients completed the follow-up more than 3 months, the operation time was 145.3minutes （70-200 min）, the blood loss was 189.3ml （50- 310 ml）. The union rate was 100% （mean time to union： 2.5 months）. The ASES score was 83.1 and Constant Score was 81.7 , while the VAS was 1.7. The Constant score 87 （85, 92） and ASES 90 （83.5, 100） were higher for 5 cases without calcar screw than those of the other 10 cases using the calcar screw whose Constant 83 （77, 90）, ASES 85 （73, 95）. The average Constant score 88 （78, 92） and ASES score 91.5 （75, 100） were higher in 7 cases with 1 screw-in-screw than those with more than 2 screw-in-screw in 8 cases whose Constant 80.5 （74, 88.5）, ASES 81.8 （73, 92.5）. There were no complications such as hardware failure, protruded screws, infection, nonunion, avascular necrosis of humeral head or impingement syndrome, but 1 patient suffered from elbow stiffness （complication rate： 6.7%）. Conclusion The Muhiloc proximal humeral nail is an effective implant for stabilisation of displaced proximal humeral fracture with a good short-term functional outcome. Its advantages are short operation time, small incision, less trauma, less blood supply and less complications. The shoulder pain history and or with intraoperative findings of rotator cuff injuries, may have a negative impact on the prognosis.