加压锁定钢板治疗肱骨外科颈骨折的效果

Effect of compression locking plate in the treatment of surgical neck fracture of humerus

目的分析肱骨近端解剖钢板和加压锁定钢板在肱骨外科颈骨折中的应用效果,为手术方案的选择提供参考。方法回顾性分析2017年1月—2019年6月平果市人民医院收治的53例NeerⅡ、Ⅲ、Ⅳ型肱骨外科颈骨折患者的临床资料,患者均为闭合性新鲜骨折,均无严重合并伤及重要神经血管损伤。采用解剖钢板内固定的25例设为对照组,采用加压锁定钢板内固定的28例设为观察组,比较两组手术相关指标、术后并发症及术后12个月肩关节功能恢复情况。结果观察组患者平均手术时间为(54.2±13.7)min,骨折平均愈合时间为(96.4±10.8)d,短于对照组的(75.6±18.3)min和(108.2±13.6)d,术中平均出血量少于对照组,差异均有统计学意义(P<0.05)。观察组患者骨折愈合后肩关节外展、内收、前屈、外旋、内旋幅度均大于对照组,差异均有统计学意义(P<0.05)。两组肩关节后伸幅度比较差异无统计学意义(P>0.05)。随访12个月,Neer肩关节功能评价显示,对照组和观察组优良率分别为88.0%、92.9%,差异无统计学意义(P>0.05)。结论肱骨近端加压锁定钢板同时具有固定和加压作用,设计更加合理,操作方便,固定牢固,可缩短手术时间和骨折愈合时间,值得临床推广应用。

Objective To analyze the application effect of proximal humeral anatomical plate and compression locking plate in the surgical neck fracture of humerus,so as to provide references for the selection of operative plan.Methods The clinical data of 53 patients with Neer typeⅡ,ⅢandⅣhumeral surgical neck fractures admitted to Pingguo People’s Hospital from January 2017 to June 2019 were retrospectively analyzed.All patients were closed fresh fractures,and there were no severe combined injuries and important neurovascular injuries.A total of 25 patients with anatomic plate internal fixation were set as control group,and 28 patients with compression locking plate internal fixation were set as observation group.The operation related indexes,postoperative complications and shoulder function recovery at 12 months after operation were compared between the two groups.Results The average operation time was(54.2±13.7)min and fracture healing time was(96.4±10.8)d of observation group,which were shorter than(75.6±18.3)min and(108.2±13.6)d of control group,and the average intraoperative blood loss was less than that of control group,and the differences were statistically significant(P<0.05).After fracture healing,shoulder abduction,adduction,flexion,external rotation and internal rotation of observation group were larger than those of control group,and the differences were statistically significant(P<0.05).There was no significant difference in the range of posterior extension of shoulder between the two groups(P>0.05).After 12 months of follow-up,the neer shoulder function evaluation showed that the excellent and good rates of control group and observation group were 88.00%and 92.86%,respectively,and the difference was not statistically significant(P>0.05).Conclusion The proximal humeral compression locking plate had the function of both fixation and compression,which was more reasonable in design,convenient in operation and firm in fixation.It could shorten the operation time and fracture healing time,which was worthy of clinical promotion and application.