摘要
目的比较分析切开复位钢板内固定和闭合复位髓内钉内固定治疗肱骨近端骨折的临床效果和安全性。方法 138例肱骨近端骨折患者,根据治疗方法不同分为钢板固定组(65例)和髓内钉固定组(73例)。钢板固定组患者采用切开复位钢板内固定术进行治疗,髓内钉固定组患者采用闭合复位髓内钉内固定术进行治疗。比较两组患者的术中出血量、术中透视次数、手术时间、骨折愈合时间及术后随访3、8个月的肩肘关节功能美国肩肘外科协会(ASES)评分。结果两组患者的术中透视次数和骨折愈合时间比较,差异均无统计学意义(P>0.05);髓内钉固定组患者的术中出血量(73.27±1.26)ml少于钢板固定组的(95.86±4.62)ml,手术时间(70.02±2.34)min短于钢板固定组的(94.18±6.69)min,差异均具有统计学意义(P<0.05)。髓内钉固定组患者术后随访3个月时的肩肘关节功能ASES评分(85.34±2.43)分显著优于钢板固定组的(72.46±4.17)分,差异具有统计学意义(P<0.05);术后随访8个月时,两组患者的肩肘关节功能ASES评分比较,差异无统计学意义(P>0.05)。结论切开复位钢板内固定和闭合复位髓内钉内固定技术治疗肱骨近端骨折均有效,在骨折愈合时间和术后随访长期肩肘关节功能评分等方面无太大差异。但在短时间内,相比于钢板内固定技术,髓内钉内固定技术手术创伤较小,术后恢复较快,肩肘关节功能评分更优,安全性更高。因此,在临床医师充分掌握治疗技术、患者身体状况和手术适应证的前提下,采用闭合复位髓内钉内固定技术治疗肱骨近端骨折是一种更佳的选择。
Objective To compare and analyze the clinical effect and safety of open reduction and plate internal fixation and closed reduction and intramedullary nail internal fixation in the treatment of proximal humeral fractures. Methods A total of 138 patients with proximal humeral fracture were divided by different treatment methods into plate fixation group(65 cases) and intramedullary nailing fixation group(73 cases). Open reduction and plate internal fixation was used in the plate fixation group, while closed reduction and intramedullary nailing internal fixation was used in the intramedullary nailing fixation group. Comparison was made on amount of intraoperative hemorrhage, intraoperative fluoroscopy frequency, operation time, fracture healing time, and American shoulder and elbow Surgeons(ASES) score of shoulder and elbow joint function after 3 and 8 months of follow-up of the two groups. Results There was no significant difference in the intraoperative fluoroscopy frequency and fracture healing time between the two groups(P>0.05). The amount of intraoperative hemorrhage of the intramedullary nailing fixation group was(73.27±1.26) ml, which was less than that of the plate fixation group as(95.86±4.62) ml, and the operation time of the intramedullary nailing fixation group was(70.02±2.34) min, which was shorter than that of the plate fixation group as(94.18±6.69) min. The difference was statistically significant(P<0.05). The ASES score of shoulder and elbow joint function in the intramedullary nail fixation group was(85.34±2.43) points, which was obviously better than that of the plate fixation group as(72.46± 4.17) points after 3 months follow-up, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the ASES score of shoulder and elbow joint function between the two groups at 8 months after operation(P>0.05). Conclusion Open reduction and plate internal fixation and closed reduction and intramedullary nail internal fixation are both effective in the treatment of proximal humeral fractures. There is no significant difference in fracture healing time and long-term shoulder and elbow joint function score after operation. But in a short time, intramedullary nail fixation has characteristics of less trauma, faster recovery, better shoulder and elbow function score, and higher safety compared with plate fixation. Therefore, closed reduction and intramedullary nail internal fixation is a better choice for the treatment of proximal humerus fracture on the premise that clinicians fully master the treatment technology, patient’s physical condition and surgical indications.
作者
张志强
夏贤生
杨忠利
彤军强
刘波
高立
曾雪松
孙世航
ZHANG Zhi-qiang;XIA Xiansheng;YANG Zhong-li(Department of Orthopaedics, Dongguan Eighth People's Hospital, Dongguan 523320, China)
出处
《中国实用医药》
2019年第25期23-25,共3页
China Practical Medicine
基金
广东省中医药局资助项目(项目编号：20111073)
关键词
钢板固定
髓内钉固定
肱骨近端骨折
临床效果
安全性
Plate fixation
Intramedullary nail fixation
Proximal humeral fracture
Clinical effect
Safety
