MultiLoc髓内钉技术在肱骨近端骨折中的应用和体会

Preliminary application and experience of MultiLoc intramedullary nail in the treament of proximal humerus fractures

目的探讨MultiLoc髓内钉治疗肱骨近端Neer分型Ⅱ、Ⅲ、Ⅳ部分骨折中的技术应用以及临床疗效。方法回顾性分析2017年12月至2019年12月手术治疗的肱骨近端骨折患者共70例,具备完整随访资料者61例,其中男 24 例、女 37例;年龄23 ~ 81岁,平均年龄(58.02±13.44)岁;Neer 分型:Ⅱ部分骨折 17例,Ⅲ部分骨折 28例,Ⅳ部分骨折16例。分别观察包括性别、年龄、术中出血量、手术时间、骨折临床愈合时间、肩关节主观评分系统(subjective shoulder rating system SSRS)、美国加州大学肩关节评分系统(University of California at LosAngeles,UCLA)(Ellman法)。结果 61例患者获得随访,随访时间3 ~ 22个月,平均6.7个月,随访期间无内固定物断裂、感染、肱骨头缺血性坏死、内翻畸形愈合和螺钉切出等并发症。2例出现肩峰下撞击征,61例均临床愈合,愈合时间11 ~ 18周,平均(13.93±1.79)周。三组患者性别、骨折临床愈合时间差异无统计学意义(P>0.05);年龄、出血量、手术时间、SSRS、UCLA评分(Ellman法)差异有统计学意义(P<0.05)。UCLA评分总体患者优良率为80.3%,其中Ⅱ、Ⅲ部分骨折优良率为86.7%,Ⅳ部分骨折优良率为62.5%。结论 MultiLoc髓内钉内固定治疗肱骨近端Neer 分型Ⅱ、Ⅲ部分骨折疗效满意,Ⅳ部分骨折虽有部分满意疗效,但整体疗效相对差。

Background Proximal humeral fractures are common osteoporotic fractures,accounting for about 10%of the elderly fractures and 39.7%of adult humeral fractures.Consensus has been reached on the preferred surgical treatment for complex and unstable proximal humerus fractures.However,there are still disputes on which internal fixation method is more scientific and reasonable.In the case of osteoporosis,and medial comminuted fractures which lack of support,locking plate fixation is prone to secondary varus deformity and neck-shift angle loss.Some scholars reported that the curative effect of third-generation straight intramedullary nail in the treatment of Neer part-2,part-3 and part-4 proximal humeral fractures were satisfactory.Objective To investigate the technical application and clinical efficacy of MultiLoc intramedullary nail in the treatment of Neer part-2,part-3 and part-4 proximal humeral fractures.Methods From December 2017 to December 2019,70 patients with proximal humeral fractures admitted to our trauma center were included in this study.There were 24 males and 37 females with an average age of(58.02±13.44)years(23 to 81 years).According to Neer classification,there were 17 cases of part-2 fractures,28 cases of part-3 fractures and 16 cases of part-4 fractures.The gender,age,intraoperative blood loss,operation duration,clinical healing time of fracture,subjective shoulder score system(SSRS)and UCLA shoulder score(Ellman method)was recorded.Results All the patients were followed up for an average of 6.7 months(3 to 22 months),and there were no complications occurred,such as internal fixator fracture,infection,humeral head necrosis,varus deformity,screw cut-out,etc.Only 2 cases had subacromial impingement syndrome.All patients obtained clinical healing,and the mean healing duration was(13.93±1.79)weeks(11 to 18 weeks).There were no significant differences in gender and clinical duration for fracture union,but the comparison results of age,blood loss,operation duration,SSRS scoring,and UCLA score had significant difference(P0.05).According to UCLA scoring system,the overall excellent and good rate was 80.3%,among which the excellent and good rate of Neer part-2 and part3 fractures was 86.7%while it was 62.5%in Neer part-4 fractures.Conclusion The curative efficacy of MultiLoc intramedullary nail for proximal humeral fractures of Neer part-2 and part-3 is satisfactory.For some of Neer part-4 fractures,the curative effect is satisfactory,but the overall effect was relatively poor.