肱骨近端䯝内钉(Multiloc髓内钉)治疗肱骨近端NeerⅡ型骨折的临床疗效观察

Clinical Observation of the Therapeutic Effect of Multiloc Intramedullary Nail in the Treatment of NeerⅡType Fractures of the Proximal Humerus

目的:探讨肱骨近端䯝内钉手术对肱骨近端NeerⅡ型骨折的效果。方法:选择于2020年3月~2023年4月在贵州省织金县人民医院治疗的肱骨近端NeerⅡ型骨折患者70例为观察对象,划分为PHILOS组和Multiloc组;分别选择PHILOS锁定钢板和Multiloc髓内钉进行固定,两组人数分别为33例和37例。设定3个观察项,第一,PHILOS锁定钢板与Multiloc髓内钉围术期情况比较:①完成手术时间;②术中使用C型臂X射线机透视次数;③切口长度;④住院时间;⑤术中出血量;⑥血红蛋白(Hb);第二,PHILOS锁定钢板与Multiloc髓内钉术后愈合情况比较:①骨折愈合时间;②肩关节活动度(前屈上举、体侧外旋、体侧内旋);第三,术后6个月疗效比较:①肩关节活动度;②Constant-Murley评分。结果:Multiloc髓内钉组在完成手术时间(74.85±14.26)min、切口长度(7.16±2.85)cm、住院时间(7.82±2.83)d、术中出血量(410.58.3±87.73)mL、术后Hb(91.45±10.52)g/L均优于PHILOS锁定钢板组,差异均有统计学意义(P<0.05)。PHILOS锁定钢板组术中透视次数少于Multiloc组,结果差异显著(P<0.05)。骨折愈合时间:PHILOS锁定钢板组9~26周,平均(17.35±3.43)周,Multiloc髓内钉组8~27周,平均(16.32±4.28)周,两组比较差异无统计学意义(P>0.05)。术后6个月时检查,Multiloc髓内钉组在肩关节前屈上举(155.72±8.72)˚、体侧内旋活动度(63.11±13.45)˚指标上均显著优于PHILOS组,差异有统计学意义(P<0.05);两组的体侧外旋活动度指标差异不显著。术后6个月对比发现,Multiloc髓内钉组Constant-Murley评分(85.32±8.61)分更高,有统计学差异(P<0.05)。结论:Multiloc䯝内钉固定治疗肱骨近端NeerⅡ型骨折的效果显著,且手术时间短、创伤小、术后功能恢复好,表现出较高的临床应用价值。

Objective:To explore the effect of proximal humeral nail surgery on NeerⅡtype fractures of the humerus.Methods:70 patients of this type who were treated at Zhijin County People’s Hospital in Guizhou Province from March 2020 to April 2023 were selected as the subjects and divided into PHILOS group and Multiloc group;PHILOS locking steel plate and Multiloc intramedullary nail were selected for fixation,with 33 and 37 cases in each group,respectively.Set 3 observation items.⑴Comparison of perioperative conditions between PHILOS locking steel plate and Multiloc intramedullary nail:①Completion time of surgery;②The number of times a C-arm X-ray machine is used for fluoroscopy during surgery;③Cut length;④Hospitalization time;⑤Intraoperative bleeding volume;⑥Hemoglobin(Hb);⑵Comparison of postoperative healing between PHILOS locking steel plate and Multiloc intramedullary nail:①fracture healing time;②Shoulder joint range of motion(flexion and lift,lateral external rotation,lateral internal rotation)Comparison of therapeutic effects 6 months after surgery:①Shoulder joint range of motion;②Constant Murley rating.Results:The Multiloc intramedullary nail group had better surgical completion time(74.85±14.26),incision length(7.16±2.85),hospital stay(7.82±2.83),intraoperative blood loss(410.58.3±87.73),and postoperative Hb(91.45±10.52)compared to the PHILOS locking plate group,and the differences were statistically significant(P<0.05).The PHILOS locking steel plate group had fewer intraoperative fluoroscopy times than the other group,and the difference in results was significant(P<0.05).Fracture healing time:The PHILOS locking plate group had a healing time of 9-26(17.35±3.43)weeks,while the Multiloc intramedullary nail group had a healing time of 8-27(16.32±4.28)weeks.There was no statistically significant difference between the two groups(P>0.05).6 months after surgery,the Multiloc intramedullary nail group showed significantly better performance in shoulder flexion and lifting(155.72±8.72)and lateral internal rotation range of motion(63.11±13.45)compared to the control group,with statistically significant differences(P<0.05);There was no significant difference in the indicators of lateral lateral rotation activity between the two groups.After 6 months of postoperative comparison,it was found that the Multiloc intramedullary nail group had a higher Constant Murley score(85.32±8.61),with a statistically significant difference(P<0.05).Conclusion:Multiloc internal nail fixation has a significant effect on the treatment of NeerⅡtype fractures of the proximal humerus,with short surgical time,minimal trauma,and good postoperative functional recovery,demonstrating high clinical application value.