新型解剖髓内支撑系统与自体髂骨填充联合钢板治疗老年肱骨近端骨折疗效比较

Novel anatomical intramedullary support system versus locking plate combined with autologous ilium crest graft in treatment of elderly patients with proximal humeral fractures

背景老年肱骨近端骨折是一种常见的脆性骨折,重建内侧柱稳定性是治疗的关键,但重建方式存在差异。目的比较新型解剖髓内支撑系统与钢板结合髂骨髓内支撑治疗老年肱骨近端骨折的疗效差异。方法回顾性分析解放军总医院骨科医学部2018年9月-2021年6月收治的肱骨近端骨折老年患者。根据治疗方式分为新型解剖髓内支撑系统组和钢板结合自体髂骨移植组。比较两组手术时间、术中出血量、切口长度、复位质量、疼痛视觉模拟评分(visual analog scale,VAS)以及末次随访时的肩关节功能Constant-Murley评分、生活能力DASH(disability of the arm,shoulder,and hand)评分、并发症等方面的差异。结果共纳入47例老年肱骨近端Neer分型骨折患者,男12例,女35例;三部分骨折25例,四部分骨折22例。新型解剖髓内支撑系统组22例,钢板结合自体髂骨移植组25例,两组一般资料差异无统计学意义(P均>0.05)。平均随访时间为18.4个月,所有患者均获得骨性愈合,观察组的切口长度、术中出血量、手术时间均短于/少于对照组[(6.43±0.78)cm vs(10.74±0.81)cm,(192.27±55.02)mL vs(250±57.8)mL,(101.27±13.8)min vs(116.72±11.24)min],差异有统计学意义(P均<0.05)。术后3个月与术后第1天相比,观察组颈干角变化值小于对照组[(0.71±0.63)°vs(3.2±1.14)°,P<0.05]。两组在末次随访时VAS疼痛评分、Constant-Murley评分、DASH评分均无统计学差异(P>0.05)。结论与自体髂骨联合钢板组相比,新型解剖髓内支撑系统组具有创伤小、维持复位能力强等优点。

Background Proximal humeral fracture is a common fragility fracture in geriatric patients,reconstruction of medial column stability is the key to the treatment,but there are differences in reconstruction methods.Objective To compare the curative effect of novel anatomical intramedullary support system versus locking plate combined with autologous ilium crest graft in the treatment of elderly patients with proximal humerus fractures.Methods A retrospective analysis was performed in the elderly patients with three-and four-part fractures of the proximal humerus admitted to the Department of Orthopaedic Medicine,Chinese PLA General Hospital from September 2018 to June 2021.According to different treatment methods,the patients were divided into observation group and control group.Patients in the observation group were treated with a novel anatomical intramedullary support system,while the control group was treated with locking plate combined with autologous ilium crest graft.The operation time,intraoperative blood loss,incision length,reduction quality,pain visual analog scale(VAS),Constant-murley score,DASH(disability of the arm,shoulder,and hand)score and complications at the last follow-up were compared between the two groups.Results There were 47 cases with proximal humerus fractures,including 25 cases of three-part fracture and 22 cases of four-part fracture by Neer classification.Twenty-two cases were in the observation group and 25 in the control group,and there was no significant difference in general information between the two groups(all P>0.05).The mean follow-up time was 18.4 months,and all patients achieved bone healing.In the observation group,the incision length([6.43±0.78]cm vs[10.74±0.81]cm),intraoperative blood loss([192.27±55.02]mL vs[250.00±57.80]mL),operation time([101.27±13.80]min vs[116.72±11.24]min)were all less than those of the control group(all P<0.05).The change value of the neck-shaft angle in the observation group was less than that of the control group([0.71±0.63]°vs[3.2±1.14]°,P<0.05).There were no significant differences in VAS pain score,Constant-murley score and DASH score between the two groups at the last follow-up(P>0.05).Conclusion Compared with the locking plate combined with autologous ilium crest graft group,the novel anatomical intramedullary support system group has the advantages of less damage and stronger ability to maintain reduction.