带锁髓内钉与锁定钢板内固定术治疗肱骨近端Neer二部分骨折患者的效果比较

Comparison of effects of interlocking intramedullary nail and locking plate internal fixation in treatment of patients with two-part Neer fracture of proximal humerus

目的:比较带锁髓内钉与锁定钢板内固定术治疗肱骨近端Neer二部分骨折患者的效果。方法:选取2021年2月至2022年2月该院收治的64例肱骨近端Neer二部分骨折患者进行前瞻性研究,按照随机数字表法将其分为观察组与对照组各32例。对照组采用锁定钢板内固定术治疗,观察组采用带锁髓内钉内固定术治疗,比较两组手术时间、术中出血量、住院时间、骨性愈合时间、ConstantMurley肩关节功能评分量表(CMS)评分、健康调查简表(SF-36)评分和并发症发生率。结果:观察组术中出血量少于对照组,住院时间和骨性愈合时间短于对照组,差异均有统计学意义(P<0.05);术后6个月,两组SF-36各维度评分高于术前,且观察组高于对照组,差异均有统计学意义(P<0.05);观察组并发症发生率为3.12%,明显低于对照组的25.00%,差异有统计学意义(P<0.05);两组手术时间和手术前后CMS评分比较,差异无统计学意义(P>0.05)。结论:带锁髓内钉内固定术治疗肱骨近端Neer二部分骨折患者可提高术后SF-36评分,缩短住院时间和骨性愈合时间,以及降低术中出血量和并发症发生率,效果优于锁定钢板内固定术治疗。

Objective:To compare effects of interlocking intramedullary nail and locking plate internal fixation in treatment of patients with two-part Neer fracture of proximal humerus.Methods:A prospective study was conducted on 64 patients with two-part Neer fracture of proximal humerus admitted to the hospital from February 2021 to February 2022.According to the random number table method,they were divided into observation group and control group,32 cases in each group.The control group was treated with locking plate internal fixation,while the observation group was treated with interlocking intramedullary nail internal fixation.The operation time,the intraoperative blood loss,the hospitalization time,the bone healing time,the Constant-Murley shoulder function score(CMS)score,the the MOS 36-item short form health survey(SF-36)score,and the incidence of complications were compared between the two groups.Results:The intraoperative blood loss in the observation group was less than that in the control group,the hospitalization time and bone healing time were shorter than those in the control group,and the differences were statistically significant(P<0.05).After 6 months after the surgery,the scores of each dimension of SF-36 in the two groups were higher than those before the surgery,those in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 3.12%,which was significantly lower than 25.00%in the control group,the difference was statistically significant(P<0.05).However,there were no significant differences in the operation time and the CMS scores before and after the surgery between the two groups(P>0.05).Conclusions:Interlocking intramedullary nail internal fixation can improve the postoperative SF-36 scores,shorten the hospitalization time and the bone healing time,and reduce the intraoperative blood loss and the incidence of complications in the patients with two-part Neer fracture of proximal humerus.Moreover,it is superior to the locking plate internal fixation.