髓内钉与锁定钢板治疗老年肱骨近端骨折疗效比较

Treatment of proximal humeral fractures in elderly patients with intramedullary nail and locking plate

目的比较髓内钉与锁定钢板治疗老年肱骨近端骨折的效果。方法选择天津医院2016年4月至2018年6月收治的37例老年肱骨近端骨折患者,男13例,女24例,年龄(66±5)岁。按照随机数字表法将患者分为观察组(17例)和对照组(20例),分别给予Multiloc髓内钉内固定和锁定钢板内固定。比较两组手术时间、术中失血量、骨折愈合时间、疼痛模拟视觉评分(VAS)、肩关节功能Neer评分。组间数据比较采用t检验。结果观察组手术时间较对照组短[(72±7)min比(89±9)min,t=6.365,P<0.05];术中出血量为(56±6)ml,低于对照组的(74±8)ml(t=7.923,P<0.05);观察组肩关节功能优良率为94.1%(16/17)、对照组为90.0%(18/20)(χ^2=0.209,P>0.05)。观察组术后1 d VAS评分为(3.6±0.8)分,低于对照组的(4.9±0.8)分(t=4.706,P<0.05);观察组术后6个月Neer肩关节功能评分为(81±8)分,高于对照组的(76±8)分(t=2.156,P<0.05);观察组术后6个月外翻角度为19.21°±2.88°,大于对照组的16.32°±2.63°(t=3.189,P<0.05),肱骨头内翻角度为3.57°±0.47°,肱骨颈干角度139°±10°,均小于对照组(分别为5.24°±1.26°和146°±13°)(t=5.159、2.258,均P<0.05)。两组术后12个月肩关节功能评分、并发症发生率差异均无统计学意义(均P>0.05)。结论髓内钉与锁定钢板治疗老年肱骨近端骨折均可获得较好的疗效,但髓内钉手术时间更短,术后疼痛轻,恢复快。

Objective To compare the effect of intramedullary nail and locking plate in the treatment of proximal humeral fractures in the elderly.Methods A total of 37 elderly patients with proximal humeral fractures were selected from April 2016 to June 2018 in Tianjin Hospital,including 13 males and 24 females,aged(66±5)years.The patients were divided into observation group(17 cases)and control group(20 cases)according to the random number table,and were treated with multiloc intramedullary nail and locking plate respectively.The operation time,blood loss,healing time of fractures,visual analogue scale of pain,Neer shoulder function score were recored and compared between the two groups.The data were compared with t test between the two groups.Results The operation time of the observation group was shorter than that of the control group((72±7)min vs(89±9)min,t=6.365,P<0.05);the intraoperative bleeding volume was lower than that of the control group((56±6)ml vs(74±8)ml,t=7.923,P<0.05).The superior rate of shoulder function was 94.1%(16/17)in the observation group and 90.0%(18/20)in the control group(χ^2=0.209,P>0.05).The VAS score of the observation group was lower than that of the control group on the first day after operation(t=4.706,P<0.05);the Neer shoulder function score of the observation group was higher than that of the control group on the sixth month after operation(81±8 vs 76±8,t=2.156,P<0.05).Six months after the operation,the valgus angle(19.21°±2.88°)of the observation group was larger than that of the control group(16.32°±2.63°,t=3.189,P<0.05),the humeral head varus angle(3.57°±0.47°),the humeral neck stem angle(139°±10°)was smaller than that of the others(5.24°±1.26°),(146°±13°)(t=5.159,2.258,both P<0.05).There was no significant difference in shoulder function score and complication rate 12 months after operation between the two groups(both P>0.05).Conclusion Both intramedullary nailing and locking plate can achieve better results in the treatment of proximal humeral fractures in the elderly,but the operation time of intramedullary nailing is shorter,the pain after operation is lighter and the recovery is faster.