第3代multiloc髓内针、普通弯型髓内针与肱骨近端锁定钢板治疗复杂肱骨近端骨折的比较

Comparison of the third generation multiloc intramedullary nail,common curved intramedullary nail and proximal humeral locking plate in the treatment of complex proximal humeral fractures

背景:对于较为复杂的肱骨近端骨折,临床中多采取植入物内固定治疗,关于何种固定方式更有优势目前仍无定论。目的:比较第3代multiloc髓内针、普通弯型肱骨髓内针与肱骨近端锁定钢板治疗复杂肱骨近端骨折(Neer 3、4部分)的效果。方法:选择2018年8月至2022年3月在镇江瑞康医院接受治疗且进行术后随访的复杂肱骨近端骨折(Neer3、4部分)患者38例,男20例,女18例,年龄57-74岁,其中13例接受第3代multiloc髓内针内固定治疗,12例接受普通弯型髓内针内固定治疗,13例接受肱骨近端锁定钢板内固定治疗。术后随访观察3组骨折愈合时间、目测类比评分、Constant-Murley肩关节评分、上肢功能障碍DASH评分与影像学检查结果。结果与结论:(1)38例患者均获得术后随访,随访时间12-18个月,3组间术后7 d的目测类比评分比较差异无显著性意义(P> 0.05),3组间骨折愈合时间比较差异无显著性意义(P> 0.05);(2)3组间术后1,3,6,12个月的患肩前屈上举、外旋、内旋、外展角度比较,差异均无显著性意义(P> 0.05);影像学检查结果显示,multiloc髓内针组术后3,6,12个月的肱骨颈干角大于普通弯型髓内针组、锁定钢板组(P <0.05),术后3,6,12个月的肱骨头内翻角、肱骨头高度丢失小于普通弯型髓内针组、锁定钢板组(P <0.05);(3)multiloc髓内针组术后1,3,6,12个月的Constant-Murley肩关节评分高于普通弯型髓内针组、锁定钢板组(P <0.05),术后1,3,6,12个月的上肢功能障碍DASH评分低于普通弯型髓内针组、锁定钢板组(P <0.05);(4)结果表明,对于复杂肱骨近端骨折(Neer 3、4部分),第3代multiloc髓内针具有显著抗压缩、抗内翻及维持颈干角度的固定优势,并具有肩关节功能恢复快等特点。

BACKGROUND:For complex proximal humeral fra ctures,internal fixation is usually used in clinical treatment.Which fixed approach has the advantage is still undecided.OBJECTIVE:To compare the efficacy of the 3generation multiloc intramedullary nail,common curved intramedullary humeral nail and proximal humeral locking plate in the treatment of complex proximal humeral fra ctures(Neer 3 and 4 parts).METHODS:A total of 38 inpatients with complex proximal humeral fractures(Neer 3 and 4 parts) treated by surgery from August 2018 to March 2022 in Zhenjiang Ruikang Hospital and undergone postoperative follow-up were selected.There were 20 males and 18 females.Their ages ranged from 57 to 74 years.Of them,13 patients received the third generation multiloc intramedullary nail fixation;12 patients received common curved intramedullary nail fixation;13 patients received proximal humeral locking plate fixation.Fra cture healing time,visual analogue scale score,Constant-M urley shoulder score,DASH score of upper limb dysfunction,and imaging examination results were observed among the three groups in follow-up.RESULTS AND CONCLUSION:(1) All 38 patients were followed up for 12 to 18 months.There was no significant difference in visual analogue scale score among the three groups at 7 days after surgery(P> 0.05).There was no significant difference in fracture healing time among the three groups(P> 0.05).(2) There was no significant difference among the three groups in the angle of shoulder forward flexion lifting,external rotation,internal rotation and abduction at 1,3,6,and 12 months after operation(P> 0.05).The imaging examination results showed that the humeral neck shaft angle of the multiloc intramedulla ry nail group was greater than that of the common curved intramedullary nail group and the locking plate group at 3,6,and 12 months after operation(P <0.05).The humeral head varus angle and humeral head height loss were lower than those in the common curved intramedulla ry nail group and the locking plate group at3,6 and 12 months after operation(P<0.05).(3) The Constant-Murley shoulder joint scores of the multiloc intramedullary nail group at 1,3,6,and 12 months after operation were higher than those of the common curved intramedullary nail group and the locking plate group(P <0.05).The DASH scores of upper limb dysfunction at 1,3,6,and 12 months after ope ration were lower than those in the common curved intramedullary nail group and the locking plate group(P <0.05).(4) The findings indicate that for complex proximal humeral fra ctures(Neer parts 3 and 4),the third generation multiloc intramedullary nail has significant advantages in anti-compression,anti-varus and maintenance of neck shaft angle fixation and has the chara cteristics of quick recove ry of shoulder function.