Philos钢板与髓内钉内固定治疗老年骨质疏松性NeerⅢ型肱骨近端骨折的疗效比较

Efficacy comparison of Philos plate and intramedullary nail in the treatment of osteoporotic proximal humeral fractures of Neer Ⅲ in elder people

目的评价Philos钢板与髓内钉内固定治疗老年骨质疏松性NeerⅢ型肱骨近端骨折的临床效果。方法选择2018年1月~2019年6月沈阳市骨科医院收治的66例老年肱骨近端骨折患者,按随机数字表法分为Philos钢板组和髓内钉组。记录两组患者的手术时间、术中出血量、骨折愈合时间和术后住院时间,并于术后6个月随访时比较两组的VAS评分、肩关节功能Constant-Murley评分、颈干角、肩关节活动度及并发症发生情况。结果66例患者均获得6~12个月的随访,平均(8.48±3.16)个月。髓内钉组的手术时间、术中出血量均显著少于Philos钢板组(P<0.05),6个月随访时髓内钉组Constant-Murley评分和肩关节外旋程度高于Philos钢板组,差异有统计学意义(P<0.05);而两组骨折愈合时间,术后住院时间,疼痛VAS评分,颈干角,肩关节前屈上举、内旋、外展比较,差异无统计学意义(P>0.05);Philos钢板组并发症发生率为9.09%,髓内钉组并发症发生率为6.06%,两组比较差异无统计学意义(P>0.05)。结论Philos钢板与髓内钉对老年骨质疏松性NeerⅢ型肱骨近端骨折均能起到良好的固定作用,髓内钉内固定优势更为突出,不仅手术时间短、术中出血量少,而且术后肩关节功能恢复更快。

Objective To evaluate the clinical effects of Philos plate and intramedullary nail in the treatment of osteoporotic proximal humeral fractures of Neer III in elder people.Methods A total of 66 elderly patients with proximal humeral fractures were selected in Shenyang Orthopedic Hospital from January 2018 to June 2019,all of them were divided into the Philos plate group and the intramedullary nail group.The operation time,intra-operative bleeding,healing time of fracture and postoperative hospital stay were recorded of the two groups.At 6 months after operation,the VAS score,Constant-Murley score of shoulder joint function,neck dry angle,shoulder joint activity and complications were compared between the two groups.Results All 66 patients were followed up for 6-12 months,with an average of(8.48±3.16)months.The operation time and intra-operative bleeding in the intramedullary nail group were significantly less than those in the Philos plate group(P<0.05).At 6 months after surgery,the Constant-Murley score and the degree of shoulder rotation in the intramedullary nail group were higher than those in the Philos plate group,and the differences were statistically significant(P<0.05).There was no significant difference between the two groups in fracture healing time,postoperative hospital stay,VAS score,neck stem angle,shoulder forward flexion and lift,internal rotation and abduction(P>0.05).The complication rate was 9.09%in the Philos plate group and 6.06%in the intramedullary nail group,there was no significant difference between the two groups(P>0.05).Conclusion Philos plate and intramedullary nail could play a good role in the fixation of osteoporotic proximal humeral fractures in elder people.The advantages of intramedullary nail were more prominent,not only the operation time was short,the amount of intraoperative bleeding was less,but also the function of shoulder joint could be recovered faster after operation.