摘要
目的比较闭合复位髓内钉与切开复位锁定接骨板固定治疗肱骨中上段骨折的疗效。方法回顾性分析2017年10月至2021年2月荆门市第一人民医院骨科和解放军中部战区总医院骨科收治的62例肱骨中上段骨折患者资料。男35例,女27例;年龄27~86岁;左侧24例,右侧38例。骨折均为新鲜骨折;按AO分型:A型16例,B型32例,C型14例。根据治疗方法不同分为2组:髓内钉组29例(采用闭合复位髓内钉内固定)和接骨板组33例(采用切开复位锁定接骨板内固定)。记录并比较两组患者的手术切口长度、手术时间、术中出血量、住院时间、骨折愈合情况及并发症发生情况。术后1周、1个月采用疼痛视觉模拟评分(VAS)评价疼痛程度,术后1、12个月采用Constant-Murley评分评价肩关节功能恢复情况。结果髓内钉组与接骨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。髓内钉组患者术后随访12~29个月,接骨板组患者术后随访15~50个月。髓内钉组手术切口长度[(4.1±0.7)cm]、手术时间[(58.3±7.7)min]、术中出血量[(52.7±6.5)mL]及住院时间[(7.3±1.5)d]均显著少于接骨板组[(21.7±2.3)cm、(95.8±11.7)min、(237.4±14.9)mL、(12.3±1.7)d],髓内钉组骨折愈合时间[(5.0±1.9)个月]长于接骨板组[(3.5±1.7)个月],术后1周、1个月髓内钉组VAS评分[(2.8±0.3)、(1.2±0.5)分]均显著低于接骨板组[(4.3±0.4)、(1.6±0.5)分],术后1个月髓内钉组Constant-Murley评分[(63.5±7.4)分]显著高于接骨板组[(54.3±6.9)分],以上项目两组间比较差异均有统计学意义(P<0.05),但术后12个月髓内钉组Constant-Murley评分与接骨板组比较差异无统计学意义(P>0.05)。两组患者术后1个月VAS评分均较术后1周显著降低,术后12个月Constant-Murley评分均较术后1周显著升高,差异均有统计学意义(P<0.05)。髓内钉组1例患者出现术中远端再骨折;接骨板组1例患者术后出现切口感染,1例患者
Objective To compare closed reduction and intramedullary nailing versus open reduction and locking plate fixation in the treatment of middle and upper humeral fractures.MethodsAretrospective case-control study was conducted to analyze the clinical data of 62 patients with middle and upper humeral fracture who had been treated at Department of Orthopaedics,The First People's Hospital of Jinmen and at Department of Orthopedics,General Hospital of PLA Central Theater from October 2017 to February 2021.There were 35 males and 27 females,aged from 27 to 86 years.The left side was affected in 24 cases and the right side in 38 cases.All fractures were fresh.According to the A0 classification,16 cases were type A,32 type B,and 14 type C.Of the patients,29 were treated with closed reduction and intramedullary nailing(intramedullary nail group)and 33 with open reduction and locking plate fixation(locking plate group).The length of incision,operation time,intraoperative blood loss,hospital stay,fracture healing and complications were recorded and compared between the 2 groups.The pain degree was evaluated by visual analogue scale(VAS)at one week and one month after operation,and the functional recovery of the shoulder was evaluated by Constant-Murley scoreat onemonthand 12months afteroperation.ResultsTherewas no significantdifference in the preoperative general data between the 2 groups,showing comparability(P>0.05).The intramedullary nail group was followed up for 12 to 29 months and the locking plate group for 15 to 50 months.In the intramedullary nail group,the length of incision[(4.1±0.7)cm],operation time[(58.3±7.7)min],intraoperative blood loss[(52.7±6.5)mL],and hospital stay[(7.3±1.5)d]were significantly less than those in the locking plate group[(21.7±2.3)cm,(95.8±11.7)min,(237.4±14.9)ml,and(12.3±1.7)d)(P<0.05).The fracture healing time in the intramedullary nail group was(5.0±1.9)months,significantly longer than that in the locking plate group[(3.5±1.7)months](P<0.05).The VAS scores at one week and one mo
作者
王庆伟
王华松
石华峰
胡寿勇
谢辉
Wang Qingwei;Wang Huasong;Shi Huafeng;Hu Shouyong;XieHui(Department of Orthopaedics,The First People's Hospital of Jinmen,Jinmen 448000,China;Department of Orthopedics,General Hospital of PLA Central Theater,Wuhan 430070,,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第11期943-949,共7页
Chinese Journal of Orthopaedic Trauma
基金
荆门市重点科技计划项目(2022YFZD018)
荆门市科学技术研究与开发计划项目(2020 YFYB085)。
关键词
肱骨骨折
骨折固定术
内
骨板
外科手术
微创性
Humeral fractures
Fracturefixation,internal
Boneplates
Surgical procedures,minimally invasive
