摘要
目的探讨Multiloc髓内钉(multiloc intramedullary nail)与弯型髓内钉内固定术对老年肱骨近端骨折(humeral proximal fractures,HPF)患者功能恢复的疗效及并发症发生率的比较。方法回顾性分析2015年1月至2018年6月,我院收治的45例老年复杂HPF患者的临床资料,男28例,女17例,年龄62~81岁,平均(65.41±5.14)岁,其中21例采用Multiloc髓内钉行骨折髓内固定术治疗(观察组),24例采用弯型髓内钉行骨折髓内固定术治疗(对照组)。比较两组的手术时间、术后引流量、术后1周疼痛视觉模拟评分(visual analogue scale,VAS)、住院时间、切口长度、术中出血量。术后随访12~14个月,评估术后12个月肩关节功能及并发症:(1)并发症:切口感染、术后关节僵硬、神经及结节损伤、固定物松动、二次手术;(2)术后6个月及12个月肩关节功能:Constant-Murley肩关节功能评分、Neer评分、ASES评分。结果本组均完成手术治疗,影像学复查结果显示术后平均3个月达到骨性愈合。观察组围术期情况与对照组各项相比,差异无统计学意义(P>0.05);两组术后6个月及12个月肩关节功能相比,差异无统计学意义(P>0.05);两组术后12个月并发症发生率相比,差异有统计学意义(P=0.03),且观察组术后12个月并发症发生率低于对照组(P<0.05)。结论对于老年复杂HPF的髓内固定治疗,Multiloc髓内钉相较于弯型髓内钉更有利于降低术后并发症的发生率。但二者在围手术期及术后肩关节功能恢复无明显区别。
Objective To investigate effects of Multiloc intramedullary nailing and curved intramedullary nailing on the function recovery and the incidence of complications in elderly patients with humeral proximal fractures(HPF).Methods A retrospective analysis of 45 elderly patients with complex HPF had been performed from January 2015 to June 2018.There were 28 males and 17 females with an average age of(65.41±5.14)years(range:62-81 years).Twenty-one patients with Multiloc intramedullary nail fixation were collected as the observation group,while 24 patients with curved intramedullary nail were collected as the control group.Operation time,postoperative drainage,visual analogue scale(VAS)1 week after surgery,hospital stay,incision and intraoperative blood loss were compared between the two groups.Patients were followed up for 12-14 months.Shoulder functions and complications 12 months after surgery:(1)Postoperative shoulder joint function:Constant-Murley shoulder joint function score,Neer score,ASES score;(2)Complications:incision infection,postoperative joint stiffness,nerve and nodule injury,fixation loosening,and secondary surgery.Results All the 45 patients completed the surgical treatment,and the imaging results showed that the bone healing was achieved about 3 months after the operation on average.There were no significant differences in perioperative data and shoulder functions between the two groups(P>0.05).The incidence of postoperative complications was significantly higher in the control group 12 months after surgery(P<0.05).Conclusions Multiloc intramedullary nailing tends to reduce the incidence of postoperative complications than the curved intramedullary nailing in the treatment of elderly patients with complex HPF.However,no significant differences are observed in perioperative data and postoperative recovery of shoulder functions between the two groups.
作者
闫晨晨
刘国辉
熊元
米博斌
刘毅
刘静
陈朗
李卉
YAN Chen-chen;LIU Guo-hui;XIONG Yuan;MI Bo-bin;LIU Yi;LIU Jing;CHEN Lang;LI Hui(Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430022,China)
出处
《中国骨与关节杂志》
CAS
2019年第11期804-810,共7页
Chinese Journal of Bone and Joint
基金
3D打印自组装水凝胶支架负载A-hBDs-L修复慢性感染创面(项目号：2017060201010192)
关键词
肩骨折
骨折固定术
髓内
老年人
Shoulder fractures
Fracture fixation,intramedullary
Aged
