闭合复位交锁髓内钉内固定术治疗老年肱骨近端骨折患者的效果

Effects of closed reduction and interlocking intramedullary nail internal fixation in treatment of elderly patients with proximal humeral fractures

目的:探讨闭合复位交锁髓内钉内固定术治疗老年肱骨近端骨折患者的效果。方法:回顾性分析2021年7月至2022年6月该院收治的66例肱骨近端骨折患者的临床资料,根据治疗方案不同将其分为观察组与对照组各33例。对照组采用切开复位钢板内固定术治疗,观察组采用闭合复位交锁髓内钉内固定术治疗。比较两组围术期指标水平、术后疼痛[视觉模拟评分法(VAS)]评分、肩关节活动度、肩关节功能(Constant-Murley评分)、肱骨颈干角及并发症发生率。结果:观察组手术时间、住院时间及骨折愈合时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);观察组术后1、3个月时的VAS评分均低于对照组,肩关节外旋、上举、前屈角度均大于对照组,差异有统计学意义(P<0.05);术后1年时,对照组肱骨颈干角较术后3个月时明显减小,而观察组肱骨颈干角未明显减小,但大于对照组,差异有统计学意义(P<0.05);观察组术后3个月、1年时Constant-Murley评分均高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.06%(2/33),低于对照组的24.24%(8/33),差异有统计学意义(P<0.05)。结论:闭合复位交锁髓内钉内固定术治疗老年肱骨近端骨折患者可减轻手术创伤,降低术后疼痛评分和并发症发生率,缩短手术时间、住院时间和骨折愈合时间,改善肩关节活动度和肩关节功能,远期疗效优于切开复位钢板内固定术。

Objective:To investigate effects of closed reduction and interlocking intramedullary nail internal fixation in treatment of elderly patients with proximal humeral fractures.Methods:The clinical data of 66 patients with proximal humeral fractures admitted to this hospital from July 2021 to June 2022 were retrospectively analyzed.According to different treatment options,they were divided into observation group and control group,33 cases in each group.The control group was treated with open reduction and plate internal fixation,while the observation group was treated with closed reduction and interlocking intramedullary nail internal fixation.The perioperative index levels,the postoperative pain score[visual analogue scale(VAS)],the shoulder joint range of motion,the shoulder joint function(Constant-Murley score),the humeral neck shaft angle,and the incidence of complications were compared between the two groups.Results:The operation time,the hospitalization time and the fracture healing time of the observation group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).The VAS scores of the observation group 1 and 3 months after the surgery were lower than those of the control group,the external rotation,lifting and flexion angles of the shoulder joint were higher than those of the control group,and the differences were statistically significant(P<0.05).1 year after the surgery,the humeral neck-shaft angle in the control group was significantly lower than that 3 months after the surgery,while the humeral neck-shaft angle in the observation group was not significantly reduced and greater than that in the control group,and the difference was statistically significant(P<0.05).The Constant-Murley scores of the observation group were higher than those of the control group 3 months and 1 year after the surgery,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 6.06%(2/33),which was lower than 24.24%(8/33)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Closed reduction and interlocking intramedullary nail internal fixation in the treatment of the elderly patients with proximal humeral fractures can reduce the surgical trauma,reduce the postoperative pain score and the incidence of complications,shorten the operation time,the hospitalization time and the fracture healing time,and improve the shoulder joint range of motion and the shoulder joint function.Moreover,the long�term effect is better than open reduction and plate internal fixation.