髓内钉与锁定钢板治疗老年肱骨近端Neer二、三部分骨折的疗效比较

Comparison of the Clinical Efficacy of Intramedullary Nail and Locking Plate in the Treatment of Neer Two- and Three-Part Fractures of the Proximal Humerus in the Elderly

目的:比较髓内钉与锁定钢板治疗老年肱骨近端Neer二、三部分骨折的疗效。方法:回顾性分析2018年1月至2021年6月康复大学青岛医院(青岛市市立医院)骨关节与运动医学科行手术治疗的61例肱骨近端Neer二、三部分骨折老年患者临床资料。根据内固定方式不同分为2组:髓内钉组29例(采用肱骨髓内钉系统固定)与锁定钢板组(采用肱骨近端锁定钢板系统固定) 32例。分析比较两组围手术期、随访及影像学资料。结果:髓内钉组和锁定钢板组患者术前一般资料比较差异均无统计学意义(P > 0.05),具有可比性。髓内钉组手术时间、切口长度、术中出血量均显著优于锁定钢板组(P 0.05)。髓内钉组不良反应发生率(6.90%, 2/29)显著低于锁定钢板组(28.13%, 9/32),差异有统计学意义(P Objective: To compare the clinical effects of the intramedullary nail and locking plate in the treat-ment of Neer two- and three-part fractures of the proximal humerus in the elderly. Methods: A ret-rospective study was performed on 61 elderly patients with Neer two- and three-part fractures of the proximal humerus who had been operatively treated at the Department of Orthopedic Surgery and Sports Medicine, Affiliated Hospital of the University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital) from January 2018 to June 2021. Of them, 29 were fixated by humeral interlocking intramedullary nails and 32 by proximal humeral locking compression plates. The documents concerning the perioperative period, follow-up, and radiographs were analyzed and compared between the two groups. Results: The differences between the general preoperative data of patients in the intramedullary nail and locking plate groups were not statistically significant (P > 0.05) and were comparable. The operating time, incision length, and intraoperative bleeding were significantly better in the intramedullary nail group than in the locking plate group (P 0.05). The incidence of adverse reactions in the intramedullary nail group (6.90%, 2/29) was significantly lower than that in the locking plate group (28.13%, 9/32), and the difference was statistically significant (P < 0.05). Conclusion: Compared with the locking plate, the intramedullary nail is more consistent with the concepts in orthopaedic enhanced recovery after surgery for the treatment of two- and three-part fractures of the proximal humerus in the elderly, and is characterized by less surgical trauma, shorter operative time, secure internal fixation, and low incidence of surgery-related adverse reactions, which can effectively relieve pa-tients’ early postoperative pain, help improve shoulder joint function and promote patients’ accel-erated rehabilitation.