髓内钉与钢板固定肱骨近端Neer3和4部分骨折比较△

Intramedullary nailing versus plate fixation of Neer 3- part or 4- part proximal humerus fractures

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 3 d 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 Neer 3 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。

Abstract:

[Objective] To compare the clinical efficacy of interlocking intramedullary nail (IIN) 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 IIN, while the re- maining 20 patients were with PHILOS. The documents regarding to perioperative period, follow-up and radiographs were compared be- tween the two groups. [Results] All the patients in both groups had operation finished successfully without serious complications. The IIN 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 signifi- cantly 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 statis- tically 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 than PHILOS group, but the difference was not statistically significant (P＞0.05) . [Conclusion] Both the intramedullary nailing and the plate fixations do achieve satisfactory clinical results for treatment of Neer 3-part or 4-part proximal humeral fractures. By comparison, the intramedullary nail has less iatrogenic injury.