肱骨髓内钉固定治疗老年肱骨近端骨折的疗效评价

Effects of improved intramedullary nailing on shoulder function and hemorheology in elderly patients with humeral neck fracture

目的探究肱骨髓内钉固定对治疗老年肱骨近端骨折患者的疗效。方法选择2016年7月至2018年2月间山东省胶州市人民医院骨科收治的老年肱骨近端骨折患者共60例进行回顾性研究,其中男性27例,女性33例;年龄60~84岁,平均(68.96±3.41)岁,平均骨折时间(1.81±0.33)周。按照随机数表法分为对照组(接受锁定钢板法治疗)和观察组(接受髓内钉固定治疗)。比较两组手术时间、术中出血量、骨折愈合时间/肩关节活动度、Constant评分以及术后并发症。检测并比较两组患者治疗前后血液流变学指标。结果观察组手术时间、术中出血量及骨折愈合时间均小于对照组(P<0.05)。观察组外旋度数高于对照组(P<0.05),两组其他肩关节功能评价指标和Constant评分相比较差异无统计学意义(P>0.05)。术前两组血液流变学指标比较差异无统计学意义(P>0.05),治疗后均有不同程度降低,治疗后观察组患者的血浆粘度、全血粘度以及纤维蛋白原水平均低于对照组(P<0.05)。对照组发生1例切口感染,4例骨折延迟愈合,3例静脉血栓,总发生率为24%。观察组发生1例切口感染,1例骨折延迟愈合和1例静脉血栓,总发生率为10%。结论肱骨髓内钉固定术对肱骨近端骨折具有较好的疗效,并且此种手术方法耗时更短、出血量更小,术后血液流变学指标变化更趋于正常值,这可能能缩短骨愈合的时间并改善预后。

Objective To investigate the effect of humerus intramedullary nailing for the treatment of elderly patients with proximal humerus fractures.Methods A retrospective study of 60 elderly patients with proximal humeral fractures admitted to the Department of Orthopaedics,Jiaozhou People’s Hospital,Shandong Province from July 2016 to February 2018 were enrolled in this study,including 27 males and 33 females,aged 60-84(68.96±3.41)years,average fracture time(1.81±0.33)weeks.According to the random number table method,the patients were divided into control group(using locking plate method)and observation group(receiving intramedullary nail fixation).The surgical time,intraoperative blood loss,fracture healing time/shoulder joint mobility,constant score,and postoperative complications were compared between the two groups.Hemorheological parameters were detected and compared between the two groups of patients before and after treatment.Results The operation time,intraoperative blood loss and fracture healing time of the observation group were all lower than that of the control group(P<0.05).The number of external rotations of the observation group was higher than that of the control group(P<0.05).There were no significant differences in the evaluation of other shoulder function and the constant score between the two groups(P>0.05).There was no significant difference in blood rheology between the two groups before operation(P>0.05).There were different degrees of reduction in the plasma viscosity,whole blood viscosity and fibrinogen level after treatment of the observation group were lower than those of the control group(P<0.05).In the control group,1 case of incision infection,4 cases of delayed fracture healing and 3 cases of venous thrombosis,the total incidence was 24%.Observation group,1 case of incision infection,1 case of delayed fracture healing and 1 case of venous thrombus,the total incidence was 10%.Conclusion The humerus intramedullary nailing has a better effect on the proximal humerus fractures,and this surgical method takes less time and has less bleeding,and the postoperative hemorheology index changes are normal,which may shorten bone healing time and improve prognosis.