PHILOS钢板与Multiloc髓内钉治疗老年肱骨近端骨折的疗效比较

Comparison of the efficacy of PHILOS plate and Multiloc intramedullary nail in the treatment of elderly proximal humerus fractures

目的探讨以PHILOS钢板与Multiloc髓内钉治疗老年肱骨近端骨折的临床疗效对比研究。方法研究分为PHILOS钢板组57和Multiloc髓内钉组49例,钢板组:男26例,女31例,年龄59岁-87岁,平均67.12±6.66岁,Neer分型2型23例,3型25例,4型9例。髓内钉组:男21例,女28例,年龄60岁-78岁,平均69.49±6.10岁,Neer2型21例,3型20例,4型8例。记录手术时间、C型臂透视次数、出血量、骨折愈合时间、术后1年记录颈干角,肩关节功能JOA评分,分析并进行疗效评价。结果手术时间:钢板组60 min-180 min,平均112.75±4.70 min;髓内钉组50 min-130 min,平均79.79±3.10 min(t=6.336,P=0.001)有差异性。C型臂透视次数:钢板组6次-20次平均9.08±2.63次,髓内钉组6-12次平均9.57±2.35次(t=-1.032,P=0.307)无差异性;出血量:钢板组303.06±79.98 ml髓内钉组;265.31±55.16 ml(t=2.692,P=0.010)有差异性;钢板组随访12-16月,平均12.08±2.91月,髓内钉组随访13-18月,平均12.37±2.36月(t=-1.436,P=0.157)无差异性;术后一年颈干角:钢板组129.47±6.40°,髓内钉组133.33±4.93(t=-3.481,P=0.001)有差异性;术后一年JOA功能评分:钢板组:78.80±4.27分,髓内钉组80.29±3.86(t=-1.959,P=0.056)无差异性。内固定失效病例钢板组2例,肱骨头坏死1例。结论锁定钢板和髓内钉治疗肱骨近端骨折均是有效治疗方法,但髓内钉组在手术时间、出血量、骨折复位方面有优势。

Objective To investigate the clinical effect of PHILOS plate and Multiloc intramedullary nail in the treatment of elderly proximal humerus fractures.Methods Forty-nine patients were divided into PHILOS plate group having 57 cases and Multiloc intramedullary nail group having 49 cases.In the plate group,there were 26 males and 31 females,aged from 59 to 87 years old with an average age of 67.12±6.66 years old.There were 23 cases belonging to Neer type Ⅱ,25 cases in Neer type Ⅲ,and 9 cases in Neer type Ⅳ.In the intramedullary nailing group,there were 21 males and 28 females,aged from 60-78 years old,with an average age of 69.49±6.10 years old.There were 21 cases in Neer type Ⅱ,20 cases in Neer type Ⅲ,and 8 cases in Neer type Ⅳ.The operation time,the number of C-arm fluoroscopy,the amount of blood loss,the time of fracture healing,the cervical trunk Angle and the JOA score of shoulder joint function were recorded one year after the operation,and the curative effect was analyzed and evaluated.Results Operation time was 60-180 minutes in plate group,and average time was 112.75±4.70 minutes.In the intramedullary nailing group,the mean time was 79.79±3.10 minutes(t=6.336,P=0.001)from 50 to 130 minutes.The C-arm fluoroscopy mean times were 9.08±2.63 times for 6-20 times in the plate group and 9.57±2.35 times for 6-12 times in the intramedullary nail group(t=-1.032,P=0.307).Blood loss was 303.06±79.98 ml in plate group and 265.31±55.16 ml in intramedullary nail group(t=2.692,P=0.010).The average follow-up was 12.08±2.91 months for the plate group and 12.37±2.36 months for the intramedullary nail group(t=-1.436,P=0.157)for 13-18 months.One year after surgery,the cervical trunk Angle was 129.47±6.40°in the plate group and 133.33±4.93°in the intramedullary nail group(t=-3.481,P=0.001).One year after surgery,JOA functional score was 78.80±4.27 in the plate group and 80.29±3.86 in the intramedullary nail group(t=-1.959,P=0.056).Failure of internal fixation occurred in 2 cases in plate group and 1 case in humeral head necrosis.Conclusion Locking plate and intramedullary nail are both effective treatments for proximal humerus fractures,but intramedullary nail method has advantages in terms of operation time,blood loss,and fracture reduction.