锁定钢板结合微创钢板接骨技术和髓内钉固定治疗老年肱骨近端骨折的疗效比较

Clinical efficacy of locking plate combined with minimally invasive plate osteosynthesis versus intramedullary nail fixation in treatment of proximal humeral fracture in the elderly

目的对比锁定钢板结合微创钢板接骨技术(MIPO)和髓内钉固定治疗老年肱骨近端骨折的疗效。方法回顾性分析2018年1月至2019年1月期间在航天中心医院骨科手术治疗的老年移位肱骨近端骨折患者51例的临床资料。依据治疗方法分为2组:MIPO组(n=29)和髓内钉组(n=22)。对比2组患者围术期指标、术后12h切口的视觉模拟量表(VAS)评分、并发症发生情况。分别于术后3、6、12个月,采用Constant-Murley评分对2组患者肩关节功能恢复情况进行评价。采用SPSS 13.0软件进行统计分析。2组间比较采用t检验或χ2检验。结果MIPO组和髓内钉组患者的手术切口长度均较小[(7.3±2.7)和(7.3±2.6)cm]、术中出血量较少[(79.7±25.7)和(78.3±21.4)ml]、手术耗时较短[(64.1±17.2)和(62.5±14.6)min]、术后12h切口VAS评分较低[(2.47±0.81)和(2.44±0.69)分],2组各指标比较差异均无统计学意义(P>0.05),且术后3、6、12个月2组患者的Constant-Murley评分差异亦无统计学意义(P>0.05)。但MIPO组患者术后并发症的发生率显著高于髓内钉组[17.24%(5/29)和9.09%(2/22),P<0.05]。结论锁定钢板结合MIPO技术和髓内钉固定治疗老年肱骨近端骨折都能获得较好疗效,髓内钉固定在控制并发症发生方面比锁定钢板结合MIPO技术更具优势。

Objective To compare the effectiveness of locking plate combined with minimally invasive plate osteosynthesis(MIPO)and intramedullary nailing in the treatment of proximal humeral fractures in the elderly.Methods The clinical data of 51 elderly patients with displaced proximal humeral fracture treated in our department from January 2018 to January 2019 were collected and analyzed retrospectively.According to the treatment,they were divided into MIPO group(n=29)and intramedullary nailing group(n=22).The perioperative indexes,visual analogue scale(VAS)score at 12 h postoperatively and incidence of complications were compared between the two groups.Constant-Murley scale was performed at 3,6 and 12 months after operation to evaluate the function of shoulder joint.SPSS statistics 13.0 was used for statistical analysis.Student′s t test or Chi-square test was employed for data com-parison between the two groups.Results The two groups both had smaller incision length[(7.3±2.7)vs(7.3±2.6)cm],less amount of intraoperative bleeding[(79.7±25.7)vs(78.3±21.4)ml],shorter operation time[(64.1±17.2)vs(62.5±14.6)min],and lower VAS score at 12h post-operatively[(2.47±0.81)vs(2.44±0.69)],and there was no significant differences between the two groups(P>0.05).No statistical difference was seen in Constant-Murley score between the two groups at 3,6 and 12 months after operation(P>0.05).However,the incidence of postoperative complications was significantly higher in the MIPO group than the intramedullary nailing group[17.24%(5/29)vs 9.09%(2/22),P<0.05].Conclusion Both locking plate combined with MIPO technology and intramedullary nail fixation can achieve better effectiveness in the treatment of proximal humeral fractures in the elderly.The latter procedure is superior to the former one in the control of complications.