髓内钉固定老年肱骨近端骨折是否重建内侧柱

Intramedullary nail fixation of proximal humerus fractures with or without medial column supporting reconstruction in elderly

摘要:

[目的] 比较Multiloc 髓内钉内固定治疗老年肱骨近端骨折（proximal humerus fractures. PHF） 是否内侧柱支撑重建的疗效。[方法] 回顾性分析本院2020 年1 月—2022 年8 月收治的84 例老年PHF 患者的临床资料。根据医患沟通结果，44例行内侧柱支撑重建联合Multiloc 髓内钉治疗（重建组），另外40 例行单纯Multiloc 髓内钉内固定（未重建组）。比较两组围手术期、随访及影像学指标。[结果] 重建组手术时间[(90.7±9.0) min vs (85.0±8.5) min, P=0.004] 显著长于未重建组，但前者的主动活动时间[(5.5±1.3) d vs (6.4±1.5) d, P=0.004]、住院时间[(7.5±1.4) d vs (8.6±2.0) d, P=0.004] 显著少于后者。两组切口总长度、术中失血量、术后引流量及切口愈合等级的差异均无统计学意义（P＞0.05）。随访时间平均（16.0±2.5） 个月，重建组完全负重时间显著早于未重建组[(82.6±9.8) d vs (115.0±17.4) d, P＜0.001]。随时间推移，两组VAS、ASES、Constant-Murley 评分及前屈上举、外展上举ROM 均显著改善（P＜0.05）。相应时间点，重建组VAS、ASES、Constant-Murley 评分均显著优于未重建组（P＜0.05）。此外，术后3 个月重建组前屈上举及外展上举ROM 显著优于未重建组（P＜0.05），但术后12 个月两组ROM 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、骨折愈合时间、术后即刻及末次随访时肱骨颈-干角（humeral neckshaftangle, HNSA） 的差异均无统计学意义（P＞0.05）。[结论] 内侧柱支撑重建联合Multiloc 髓内钉内固定治疗老年PHF 安全有效，有利于功能恢复，改善肩关节活动度。

Abstract:

[Objective] To compare the clinical efficacy of Multiloc intramedullary nail fixation of proximal humerus fractures (PHF)with or without medial column supporting reconstruction in the elderly. [Methods] A retrospective study was done on 84 elderly patientswho receive Multiloc intramedullary nail fixation for PHF in our hospital from January 2020 to August 2022. According to doctor-patientcommunication, 44 patients underwent the fixation with medial column supporting reconstruction (the reconstruction group), while the other40 patients underwent Multiloc intramedullary nail fixation alone (the non-reconstruction group). The perioperative period, follow-up andimaging parameters were compared between the two groups. [Results] Although the reconstruction group consumed significantly longer op-erative time than the non-reconstruction group [(90.7±9.0) min vs (85.0±8.5) min, P=0.004], the former was significantly superior to the lat-ter in terms of time to regain initiative activity [(5.5±1.3) days vs (6.4±1.5) days, P=0.004] and the hospital stay [(7.5±1.4) days vs (8.6±2.0)days, P=0.004]. There were no significant differences in the total incision length, intraoperative blood loss, postoperative drainage volumeand incision healing grade between the two groups (P＞0.05). The mean follow-up time was of (16.0±2.5) months, while the reconstructiongroup resumed full weight-bearing activities significantly earlier than the non-reconstructed group [(82.6±9.8) days vs (115.0±17.4) days,P＜0.001]. The VAS, ASES, Constant-Murley scores were significantly improved in both groups over time (P＜0.05), in which the reconstruc-tion group was significantly better than the non-reconstruction group at all time point accordingly (P＜0.05). In addition, the reconstructiongroup was also significantly better than the non-reconstruction group in forward flexion uplifting and abduction uplifting range of motions(ROMs) at 3 months after surgery (P＜0.05), but which became not significant different between the two groups at 12 months after surgery(P＞0.05). Regarding imaging, there were no significant differences in fracture reduction quality, fracture healing time and humeral neck-shaft angle (HNSA) immediately after surgery or at the last follow-up between the two groups (P＞0.05). [Conclusion] Medial column supporting reconstruction combined with Multiloc intramedullary nail fixation is safe and effective in the treatment of elderly PHF, which isconducive to functional recovery and improvement of shoulder joint motion.