干骺端锁定髓内钉与锁定钢板固定治疗肱骨外科颈两部分骨折的临床对比研究

Clinical comparative study of metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture

目的探讨干骺端锁定髓内钉与锁定钢板固定在治疗肱骨外科颈两部分骨折的临床疗效差异。方法选择2010年1月至2015年12月来本院接受治疗的NeerⅡ型肱骨外科颈两部分骨折患者64例。根据患者手术方案分为干骺端锁定髓内钉内固定治疗组(观察组,n=42)和锁定钢板固定治疗组(对照组,n=22)。比较两组患者在临床资料(性别、年龄、伤后至手术时间、受伤类型例数、随访时间)、临床指标(术后颈干角、末次颈干角、并发症例数、手术出血量、手术输血量、手术时间、骨折愈合时间)、Neer肩关节功能评分和Constant肩关节评分方面的差异。结果两组患者在性别、年龄、伤后至手术时间、受伤类型、随访时间方面差异无统计学意义(P>0.05),研究对象具有可比性。两组患者在术后颈干角、末次颈干角、并发症例数方面差异无统计学意义(P>0.05);观察组手术时间明显长于对照组(P<0.05);观察组手术出血量、手术输血量、骨折愈合时间均明显少于对照组(P<0.05)。观察组及对照组术后均发生2例切口感染,经抗感染支持治疗、换药后创面愈合。观察组患者Neer肩关节功能评分优良率88.10%,明显高于对照组的63.64%(P<0.05)。两组患者内旋角度比较差异无统计学意义(P>0.05),观察组患者Constant评分、外旋、外展、前屈角度均明显大于对照组(P<0.05)。结论利用干骺端锁定髓内钉治疗肱骨外科颈两部分骨折临床疗效确切、并发症发生率低,值得临床推广应用。

Objective To investigate the difference of clinical efficacy between metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture. Methods 64 patients with Neer II humeral surgical neck fracture who were treated in our hospital from January 2010 to December 2015 were selected. According to the operation plan,the patients were divided into epiphyseal locking intramedullary nail fixation group( observation group,n = 42) and locking plate fixation group( control group,n = 22). The differences of clinical data( sex,age,time from injury to operation,number of injured cases,follow-up time),clinical indicators( neck-trunk angle,last neck-trunk angle,number of complications,amount of operative bleeding,amount of operative blood transfusion,operation time,fracture healing time) : Neer shoulder function score and Constant shoulder score were compared between the two groups. Results There was no significant difference in gender,age,time from injury to operation,number of cases of injury and follow-up time between the two groups,and the subjects were comparable( P >0. 05). There was no significant difference in the neck-trunk angle,the last neck-trunk angle and the number of complications between the two groups( P > 0. 05);the observation group had longer operation time,less operation bleeding volume and blood transfusion volume,shorter fracture healing time( P < 0. 05). Two cases of wound infection occurred in the observation group and the control group after operation. The wound healed after anti-infection supportive treatment and dressing change. The excellent and good rate of Neer shoulder function score in the observation group was 88. 10%,which was significantly higher than 63. 64%in the control group( P < 0. 05). There was no significant difference in internal rotation between the two groups( P > 0. 05). The Constant score,external rotation,abduction and flexion in the observation group were significantly higher than those in the control group( P < 0. 05). Conclusions The use of metaphyseal locking intramedullary nail in the treatment of humeral surgical neck fracture has a definite clinical effect and a low incidence of complications,which is worthy of clinical application.