髓内钉与钢板固定肱骨近端2、3部骨折比较

Intramedullary nail versus locking plate for Neer two- and three-part proximal humeral fractures

摘要:

［目的］比较髓内钉与锁定钢板固定肱骨近端 Neer 2、3 部骨折的临床疗效。［方法］2018 年 2 月—2021 年 2 月手术治疗肱骨近端 Neer 2、3 部骨折 99 例患者。根据术前医患沟通结果，57 例采用髓内钉内固定治疗（髓内钉组），42 例采用锁定钢板内固定治疗（钢板组）。比较两组围术期资料、随访结果以及影像资料。［结果］两组患者均顺利完成手术。髓内钉组切口长度、术中出血量、手术时间、住院时间均显著优于钢板组 （P<0.05），两组早期并发症发生率差异无统计学意义 （P>0.05）。 两组患者均获随访 14~31 个月，平均 （20.88±4.86） 个月，髓内钉组临床骨折愈合时间显著早于钢板组 （P<0.05）。随时间推移，两组的 VAS 评分、前屈上举 ROM、外展上举 ROM、Constant-Murley 评分、外展肌力均显著改善 （P<0.05）。相应时间点，两组间上述各指标的差异均无统计学意义（P>0.05）。影像方面，两组骨折复位质量的差异无统计学意义（P>0.05）。髓内钉组骨折影像愈合时间显著早于钢板组 （P<0.05）。与术前相比，术后两组 NSA 均显著增加 （P<0.05）；相应时间点，两组间 NSA 的差异均无统计学意义（P>0.05）。［结论］肱骨近端 Neer 2、3 部骨折采用髓内钉与锁定钢板固定均可取得满意的临床效果，相比之下，髓内钉创伤更小，骨折愈合更快。

Abstract:

[Objective] To compare the clinical outcomes of intramedullary nail versus locking plate for open reduction and internal fix- ation (ORIF) of Neer two- and three-part proximal humeral fractures. [Methods] From February 2018 to February 2021, 99 patients re- ceived ORIF for Neer two- and three- part proximal humeral fractures. According to preoperative doctor- patient communication, 57 pa- tients were treated with intramedullary nail (IMN group) , while the other 42 patients had locking plate used (LP group) . The documents re- garding to perioperative period, follow- ups and radiographs were compared between the two groups. [Results] All the patients in both groups had ORIF performed successfully. The IMN group proved significantly superior to LP group in terms of incision length, intraopera- tive blood loss, operation time and hospital stay (P<0.05) , although there was no significant difference in the incidence of early complica- tions between the two groups (P>0.05) . All patients were followed up for 14~31 months, with an average of (20.88±4.86) months. The IMN group got clinical fracture healing significantly earlier than LP group (P<0.05) . The VAS score, forward flexion and lifting range of motion (ROM) , abduction and lifting ROM, Constant-Murley score, and abductor strength were significantly improved in both groups over time (P< 0.05) , which were not statistically significant between the two groups at any corresponding time points (P>0.05) . Radiographically, there was no significant difference in fracture reduction quality between the two groups (P>0.05) , however, the IMN group achieved fracture heal- ing on images significantly earlier than LP group (P<0.05) . Compared with those preoperatively, the neck-shaft angle (NSA) of the humer- us was significantly increased in both groups postoperatively (P<0.05) , whereas which proved not statistically significant between the two groups at any matching time points (P>0.05) . [Conclusion] Both intramedullary nail and locking plate do achieve satisfactory clinical out- comes of internal fixation of Neer two- and three-part proximal humeral fractures. In comparison, intramedullary nail takes advantages of less trauma and faster fracture healing over the plate.