带锁髓内钉与锁定钢板治疗老年肱骨近端骨折的临床疗效对比分析

Comparative analysis of clinical efficacy of the proximal humerus fractures in elderly treated with interlocking intramedullary nail and the locking plate

目的比较分析带锁髓内钉与锁定钢板治疗老年肱骨近端骨折的临床疗效。方法收集2014年3月-2015年1月期间我院就诊的老年肱骨近端骨折患者92例，将患者按照随机数字表法分为两组，A组和B组，每组46例，A组采用带锁髓内钉治疗，B组采用锁定钢板治疗，比较两组患者肩关节功能优良率、术中情况、骨折愈合时间及随访Constant—Mudev评分、并发症发生情况。结果A组切口长度为（3．1±0．4）cm，小于B组的（11．7±2．5）cm，出血量为（89．5±14．9）mL，少于B组的（145．3±21．8）mL，手术时间为（72．6±13．7）min，短于B组的（90．8±16．2）min，术后3个月、6个月Constant—Murley评分为（78．5±12．8、81．8±13．6）分，明显高于B组的（71．3±11．5、78．2±12．9）分，两组差异有统计学意义（P〈0．05）；两组骨折愈合时间[（2．8±0.3）月vs（3．3±0．5）月]、肩关节功能优良率（93．48％vs84．78％）、术后12个月两组Constant—Mudey评分（86．1±14．7vs84．9±14．1）、并发症发生率（21．74％vs 515．22％）比较，差异无统计学意义（P〉0．05）。结论带锁髓内钉与锁定钢板治疗老年肱骨近端骨折均可取得较好的效果，但带锁髓内钉治疗老年肱骨近端骨折患者优势更显著，如在条件允许的情况下，应将带锁髓内钉作为手术治疗老年肱骨近端骨折的首选方案。

Objective To compare the clinical efficacy of the elderly patients with proximal humerus fractures treated with interlocking intramedullary nail and the locking plate. Methods 92 patients of elderly proximal humerus fractures were selected from March 2014 to January 2015 in our hospital, all of them were randomly divided into two groups, group A and group B, there were 46 cases in each group, group A used interlocking intramedullary nail treatment, group B used locking plate treatment, the shoulder function excellent rate, intraoperative conditions, fracture healing time and follow-up Constant-Murley score, complications of two groups were compared. Results The incision length of group A was （3.1±0.4） era, less than （ 11.7±2.5 ）em of group B, the less blood loss was （89.5± 14.9） mL, smaller than （145.3±21.8）mL of group B, the operative time was（72.6±13.7）min, shorter than（90.8±16.2）min of group B, Constant- Murley score after 3 months,6 months was （78.5±12.8, 81.8±13.6） scores, significantly higher than （71.3±11.5, 78.2± 12.9）scores of group B, the difference was statistically significant（P〈0.05） ; Compared with group B, the fracture healing time[（2.8±0.3）months vs （3.3±0.5）months], shoulder function good rate（93.48% vs 84.78%）, Constant-Murley scores after 12 months（86.1±14.7 vs 84.9±14.1）, the complication rate（21.74% vs 15.22%） of group A were no significant differences（P〉0.05）. Conclusion The effect of elderly patients with proximal humerus fractures treated with interlocking intramedullary nail or locking plate can is good, hut the advantages of the interlocking intramedullary nail is more significant, we should accept the interlocking intramedullary nail surgery as the preferred solution elderly proximal humerus fractures as under conditions permitting.