PHILOS锁定钢板与髓内钉治疗297例肱骨近端骨折患者的疗效对比研究

A comparative study of the clinical effect of PHILOS locking plate and intramedullary nail in the treatment of 297 proximal humerus fracture patients

目的对比PHILOS锁定钢板和髓内钉内固定手术治疗肱骨近端骨折的临床疗效。方法回顾性分析2015年1月至2019年1月期间因肱骨近端骨折于本院骨科行手术治疗的患者297例,根据手术方法分为PHILOS组(n=150)和髓内钉组(n=147),收集患者手术时长,住院总时长,平均切口长度,术中输血率,术后6 h、12 h、24 h、36 h与72 h疼痛视觉模拟评分(VAS),院内感染率等围术期相关参数,统计术后6、12、24个月时的Constant-Murley肩关节功能评分与术后并发症发生情况。结果在手术时长、住院总时长、平均切口长度、术中输血率、院内感染率、术后6、12 h VAS、术后肩峰撞击症并发症方面,PHILOS组患者明显高于髓内钉组患者(P<0.05);在术后24、36、72 h VAS、骨折再移位、内固定物断裂、肱骨头坏死并发症、术后6、12、24个月Constant-Murley肩关节功能评分方面,两组患者比较差异均无统计学意义(P>0.05)。结论PHILOS锁定钢板和髓内钉均能在肱骨近端骨折的内固定手术中取得良好术后疗效,但考虑并发症发生、术中操作损伤程度的因素,髓内钉内固定手术更为合适。

Objective To compare the clinical effect of PHILOS locking plate and intramedullary nail in the treatment of proximal humerus fracture.Methods Retrospectively analyzed 297 patients with proximal humeral fracture and suffered surgery in our hospital during the period of January 2015 to January 2019.According to the operation methods patients were divided into PHLIOS group(n=150)and the intramedullary nailing group(n=147).The patient surgery time,the average length of incision,intraoperative blood transfusion rate,pain visual analogue scale(VAS)of postoperative 6 h,12 h,24 h and 36 h and 72 h,the total duration of perioperative nosocomial infection rate and hospitalization time were collected.At the same time,follow-up was conducted,and the Constant-Murley shoulder function score and postoperative complications were collected in 6,12 and 24 months after surgery.Results The length of operation,total length of hospital stay,mean incision length,intraoperative blood transfusion rate,nosocomial infection rate,6 h,12 h postoperative VAS and postoperative acromial impingement complications in the PHILOS group were significantly higher than those in the intramedullary nail group(P<0.05).In terms of the postoperative 24,36,72 h VAS,fracture re-displacement,internal fixation fracture,humeral head necrosis complications,and postoperative Constant-Murley shoulder functional score,there were no statistically significant differences between the two groups(P>0.05).Conclusion Both PHILOS locking plate and intramedullary nail can achieve good results in the internal fixation of proximal humerus fractures,but considering the complications and the degree of intraoperative injury,intramedullary nail is more appropriate.