Multiloc髓内钉与Philos钢板治疗Neer二、三部分肱骨近端骨折的疗效比较

Multiloc intramedullary nailvsPhilos plate fixations in the treatment of Neer two⁃or three⁃part proximal hu⁃merus fracture

目的比较Mutiloc髓内钉与Philos钢板治疗Neer二、三部分肱骨近端骨折的疗效差异。方法回顾性分析2015年1月至2019年6月我院收治的93例Neer二、三部分肱骨近端骨折的临床数据,根据内固定方式分为Mutiloc髓内钉组(n=30)和Philos钢板组(n=56)。记录两组患者手术时间、术中出血量和术后并发症,术后12周和末次随访时采用视觉模拟量表(VAS)评分、美国肩肘外科协会(ASES)评分及Constant评分评估肩关节功能,对以上指标进行比较。结果随访时间(59.2±26.5)周。与Philos钢板组相比,Multiloc髓内钉组手术时间更短(P=0.013)、术中出血量更少(P<0.001);术后12周随访VAS评分更低(P<0.001),ASES评分、Constant评分更高(PASES=0.011,Pconstant=0.030),差异有统计学意义。末次随访两组VAS评分、ASES评分、Constant评分、术后并发症发生率相比较,差异无统计学意义(P_(vas)=0.308,P_(ASES)=0.105,P_(constant)=0.15,P_(并发症)=0.818)。结论Mutiloc髓内钉与Philos钢板治疗Neer二、三部分肱骨近端骨折均能取得良好的短期疗效,前者在手术时间、术中出血量、术后早期康复方面更具优势。

Objective To compare the therapeutic effects between Mutiloc intramedullary nail and Philos plate in the treatment of Neer two⁃or three⁃part proximal humerus fractures(PHF).Methods Clinical data of 93 patients with Neer two⁃or three⁃part PHF admittedin our hospital from January 2015 to June 2019 were analyzed retrospectively and were divided into Mutiloc intramedullary nail group(n=30)and Philos plate group(n=56)according to internal fixation procedures.The operation time,intraoperative estimate blood loss and postoperative complications were recorded,visual analogue scale(VAS)score,American Shoulder and Elbow Surgeons(ASES)score and Constant shoulder function score of the shoulder joint were used to evaluate the shoulder joint function at 12 weeks after operation and the last follow⁃up,and the above indexes were compared between two groups.Results The follow⁃up time was(59.2±26.5)weeks.Compared with the Philos plate group,the Multiloc intramedullary nail group had shorter operation time(P=0.013)and less intraoperative blood loss(P<0.001).At the follow⁃up of 12 weeks after operation,the VAS score was lower(P<0.001),ASES score and Constant score were higher(PASES=0.011,Pconstant=0.030),and the difference was statistically significant.At the last follow⁃up,there was no significant difference in VAS score,ASES score,Constant score and the incidence of complications between the two groups(P_(vas)=0.308,P_(ASES)=0.105,P_(constant)=0.15,P_(complications)=0.818).Conclusion Both Mutiloc intramedullary nail and Philos plate fixations couldachieve good short⁃term outcomesin the treatment ofNeer two⁃or three⁃part PHF,and the former has shorter operation time,less intraoperative blood lossand better postoperative rehabilitation.