摘要
[目的]比较交锁髓内钉与PHILOS钢板治疗Neer 3、4部分肱骨近端骨折(proximal humeral fracture,PHF)的临床疗效.[方法]回顾性分析2018年2月-2020年5月在本院行内固定手术治疗的Neer 3部或4部PHF 40例患者的临床资料.依据术前医患沟通结果,20例行交锁髓内钉固定,20例行PHILOS钢板固定.比较两组围手术期、随访及影像学资料.[结果]两组患者均顺利完成手术,术中均未发生严重并发症.髓内钉组手术时间、术中出血量、切口长度、术后引流量均显著优于钢板组(P<0.05);两组术中透视次数、切口愈合、平均住院时间差异无统计学意义(P>0.05).两组患者随访12~18个月,平均(14.48±3.16)个月.螺钉组主动活动时间显著早于钢板组(P<0.05),但两组恢复完全负重活动时间的差异无统计学意义(P>0.05).与术后3个月相比,末次随访时两组患者VAS评分显著下降、肩前屈上举ROM、Neer评分和ASES评分显著增加(P<0.05).相应时间点,两组间VAS评分、ROM、Neer评分和ASES评分的差异均无统计学意义(P>0.05).影像方面,术后3d内复查X线片显示两组骨折复位质量的差异无统计学意义(P>0.05).髓内钉组影像骨折愈合时间早于钢板组,但差异无统计学意义(P>0.05).[结论]髓内钉与钢板固定治疗Neer3或4部分骨折均可取得满意临床效果,相比之下,交锁髓内钉固定的医源性损伤更小.
[Objective]To compare the clinical efficacy of interlocking intramedullary nail(UN)versus proximal humeral internal locked system plate(PHILOS)for internal fixation of Neer 3-part or 4-part proximal humeral fractures(PHF).[Methods]A retrospective study was conducted on 40 patients who received open reduction and internal fixation for Neer 3-part or 4-part PHF from February 2018 to May 2020.According to the results of preoperative doctor-patient communication,20 patients had the fractures fixed with UN,while the remaining 20 patients were with PHILOS.The documents regarding to perioperative period,follow-up and radiographs were compared between the two groups.[Results]All the patients in both groups had operation finished successfully without serious complications.The UN group proved significantly superior to the PHILOS in terms of operation time,intraoperative blood loss,incision length and postoperative drainage volume(P<0.05),and there were no significant differences in intraoperative fluoroscopy frequency,wound healing and hospital stay between the two groups(P>0.05).All patients in both groups were followed up for 12-18 months,with a mean of(14.48±3.16)months.There was a statistically significant difference in the time to return to active activity between the two groups(P<0.05),and no statistically significant difference in the time to full weight-bearing activity(P>0.05).Compared with those 3 months after surgery,VAS score significantly decreased,whereas the forward flexion range of motion(ROM),Neer and ASES scores significantly increased in both groups at the latest follow-up(P<0.05).However,there were no statistically significant differences between the two groups in the VAS score,ROM,Neer and ASES scores between the two groups at any corresponding time point postoperatively(P>0.05).Radiographically,there was no a statistically significant difference between the two groups in fracture reduction quality revealed by radiographs within 3 days after surgery(P>0.05).The INN group got fracture healing earlier t
作者
罗仲伟
程飞
何超
龚广政
张镇
沈金虎
杨六中
LUO Zhong-wei;CHENG Fei;HE Chao;GONG Guang-zheng;ZHANG Zhen;SHEN Jin-hu;YANG Liu-zhong(Department of Orthopedic Traumatology,Xu-zhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Xuzhou 221000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第8期689-694,共6页
Orthopedic Journal of China
基金
徐州市卫生健康委科技项目(编号:XWKYHT20200051)。
关键词
肱骨近端骨折
Neer分型
交锁髓内钉
PHILOS钢板
proximal humeral fractures
Neer classification
interlocking intramedullary nail
proximal humeral internal locked system plate
