闭合复位髓内钉内固定治疗老年肱骨外科颈骨折临床观察

Closed reduction and intramedullary nailing for the treatment of elderly humeral surgical neck fracture

目的观察闭合复位髓内钉内固定和锁定钢板内固定治疗老年肱骨外科颈骨折的效果及其对肩关节功能的影响。方法选择老年肱骨外科颈骨折患者86例,按照内固定方式不同分为观察组和对照组各43例。对照组予以切开复位和锁定钢板内固定治疗,观察组予以闭合复位和髓内钉治疗。比较2组临床疗效、并发症发生率、切口长度、手术时间、术中出血量、骨折愈合时间、Constant-Murley评分、术后颈干角和肩关节活动度。结果2组临床疗效和总优良率差异无统计学意义(P>0.05)。观察组切口长度、手术时间、骨折愈合时间明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P<0.05);2组Constant-Murley评分和术后颈干角差异均无统计学意义(P>0.05)。治疗后2组前屈、后伸、外展、内收、外旋和内旋角度差异均无统计学意义(P>0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论闭合复位髓内钉内固定治疗老年肱骨外科颈骨折与锁定钢板内固定治疗疗效相似,且具有微创、出血少、手术时间短和骨折愈合快等优点。

Objective To observe the efficacy of closed reduction intramedullary nailing and locking plate internal fixation in elderly patients with humeral surgical neck fractures and their impact on shoulder joint function.Methods The 86 elderly patients with fractured humeral neck fracture were divided into observation group and control group according to different internal fixation methods,each group had 43 cases.Control group was performed with open reduction and locking plate fixation,the observation group was given with closed reduction and intramedullary nailing.The clinical efficacy,complications rate,incision length,operation time,intraoperative blood loss,fracture healing time,Constant-Murley score,postoperative neck shaft angle and shoulder joint activity were compared between two groups after treatment.Results There was no significant difference in clinical efficacy and total excellent rate between the two groups(P>0.05).The length of incision,operation time and fracture healing time in the observation group were significantly shorter compared with the control group,and the intraoperative blood loss was also significantly lower than that of the control group,and the difference was statistically significant(P<0.05).There was no significance difference of Constant-Murley score and postoperative neck shaft angle between two groups(P>0.05).There were no significant differences in the flexion,extension,abduction,adduction,external rotation and internal rotation between two groups after treatment(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The efficacy of closed reduction intramedullary nailing is obvious as the same efficacy as locking plate fixation in elderly patients with humeral surgical neck fractures,with minimal invasion,less bleeding,shorter operative time and faster fracture healing.