锁定钢板与髓内钉治疗肱骨近端骨折的比较

Locking plate versus intramedullary nailing for proximal humeral fractures

[目的]比较锁定钢板与髓内钉治疗2部分及3部分肱骨近端骨折的临床效果。[方法]回顾性分析97例行手术治疗的肱骨近端骨折患者的临床资料。其中50例采用锁定钢板内固定,另外47例采用髓内钉内固定。两组患者术前资料比较,差异均无统计学意义(P>0.05)。比较两组切口长度、手术时间、出血量、住院时间、切口愈合时间、骨折愈合时间、肩关节功能评分、术后肱骨颈干角及患肩前举角度。[结果]虽然锁定钢板组相比交锁髓内钉组的平均切口长度更大、平均手术时间更长、平均出血量更多,差异均存在统计学意义(P<0.05),但两组在住院时间、切口愈合时间、骨折愈合时间、肩关节功能评分、肱骨颈干角及患肩前举角度比较,差异无统计学意义(P>0.05)。晚期并发症方面:锁定钢板组晚期并发症发生率为16.00%,交锁髓内钉组发生率为23.40%,两组间差异无统计学意义(P>0.05)。[结论]对于Neer 2部分和3部分肱骨近端骨折,髓内钉和肱骨近端钢板均能可靠的进行内固定术治疗,疗效无明显差异。对于外翻型骨折,锁定钢板固定是较好的选择;对于内翻型骨折,髓内钉固定更具优势。对于伴有大结节骨折的肱骨近端骨折,用髓内钉固定时,建议增加辅助内固定手段,防止出现术后大结节骨折块移位。

[Objective] To compare the clinical outcomes of locking plate versus intramedullary nailing for proximal humeral fractures.[Methods] A total of 97 patients with Neer two-part or three-part proximal humeral fractures were included in the present study. Of them, 50 patients had fracture fixed internally with locking plate, while the remaining 47 patients received internal fixation for the fractures with intramedullary nailing. There were no statistically significant differences in preoperative data between the two groups（P〉0.05）. The length of the surgical incision, operation time, bleeding, hospital stays, incision healing time, fracture healing time, function recovery and postoperative complication were compared between the two groups. [Results] Although the locking plate group had statistically larger length of the surgical incision, longer operating time and more bleeding than the intramedullary nailing group（P〈0.05）, no significant differences were noticed between the two groups in hospital stays, incision healing time, fracture healing time, humerus neck-shaft angle and shoulder functional scores（P〉0.05）.In term of late complication, the locking plate group proved 16.00%, while the intramedullary nailing group was 23.40%, without significant difference between the two groups（P〉0.05）. [Conclusion] Both the locking plate and intramedullary nailing are effective for Neer two-part or three-part proximal humeral fractures with similar consequences. The locking plate takes an advantage over nailing for the abduction type of fracture, conversely the nailing is a better option for the adduction type, To avoid the postoperative displacement of greater tuberosity, the auxiliary internal fixation is necessary when nailing were used to treat proximal humeral fractures accompanied with greater tuberosity fractures.