摘要
目的探讨交锁髓内钉与锁定钢板治疗肱骨近端骨折的疗效对比。方法将2015年5月至10月第二军医大学附属长海医院创伤骨科收治的51例肱骨近端骨折患者按手术方式分为髓内钉组(n=25)及锁定钢板组(n=26)。记录患者平均手术时间、术中出血量、住院时间、骨折愈合时间、术后并发症的发生情况,采用肩关节Neer评分法和美国肩与肘协会评分系统(American shoulder elbow surgeons'form,ASES)综合评估肩关节功能。结果髓内钉组患者各项手术指标显著优于锁定钢板组(P<0.05)。髓内钉组术后并发症发生率为4.00%,锁定钢板组术后并发症发生率为23.08%,髓内钉组术后并发症发生率低于锁定钢板组。两组患者术后5个月肩关节功能优良率分别为96.00%、88.46%,髓内钉组肩关节功能优良率明显高于锁定钢板组(P<0.05)。结论交锁髓内钉用于治疗肱骨近端骨折,能缩短手术时间、住院时间,减少出血量,在固定骨折稳定性方面与锁定钢板固定相比并没有明显的差异,在手术并发症方面也较锁定钢板固定更具优势,值得临床推广。
Background Proximal humerus fracture accounts for 5%of limb fractures,and the incidence affects 105-342/10 000 people per year.While non-displaced fractures are usually treated conservatively,displaced fractures are treated by surgery.As elderly patients with osteoporosis usually suffer from low energy injury that causes stable or slightly displaced fractures,most of them can obtain the recovery of shoulder joint function with conservative treatment with only about 20%of patients required for surgery.It is generally accepted that surgical treatment should be considered if the displacement of head and shaft is over 50%of shaft diameter,or the angle of varus or valgus is 20°greater than the normal head-shaft angle.Operative treatment methods include transosseous suture fixation,Kirschner wire fixation,intramedullary nail fixation and locking plate fixation.Intramedullary nail fixation and locking plate fixation are more applicable clinically.Intramedullary nailing is indicated for minimally displaced Part-3 and Part-4 fractures that involve humeral metaphyseal or shaft,while open reduction and interal plate fixation is indicated for Part-2,Part-3 and Part-4 fractures that involve greater and lesser tuberosity or humeral head.It is widely accepted that better anatomic reduction can be obtained by open fixation,but the rate of operative complications is higher.Intramedullary nailing is less traumatic,but its fixation stability is inferior to that of locking plate.Thus,the choice of operative methods is still controversial.Studies have shown that intramedullary nailing is superior to plate and has lower complication rate.However,another multicenter study shows that there is no significant difference in curative effect and the incidence of complications between two methods after long-term follow-ups.Intramedullary nail fixation leads to a higher rate of iatrogenic rotator cuff injury which requires further arthroscopic treatment.Therefore,there is still not enough clear guideline or evidence to guide the clinical trea
作者
周启荣
曹烈虎
翁蔚宗
陈晓
张军
汪林
王尧
苏佳灿
Zhou Qirong;Cao Liehu;Weng Weizong;Chen Xiao;Zhang Jun;Wang Lin;Wang Yao;Su Jiacan(Department of Orthopaedic Surgery,Changhai Hospital,Second Military Medical Univer sity,Shanghai 200433,China)
出处
《中华肩肘外科电子杂志》
2017年第2期84-89,共6页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
国家自然国际合作基金(8141101156)
上海市科委生物医药专项(154119500600)
关键词
肱骨近端骨折
交锁髓内钉
锁定钢板
Proximal humeral fracture
Intramedullary nail
Locking plate
