髓内钉与锁定钢板治疗老年肱骨近端Neer二、三部分骨折的疗效比较

Comparison of the Clinical Efficacy of Intramedullary Nail and Locking Plate in the Treatment of Neer Two- and Three-Part Fractures of the Proximal Humerus in the Elderly

摘要: 目的：比较髓内钉与锁定钢板治疗老年肱骨近端Neer二、三部分骨折的疗效。方法：回顾性分析2018年1月至2021年6月康复大学青岛医院(青岛市市立医院)骨关节与运动医学科行手术治疗的61例肱骨近端Neer二、三部分骨折老年患者临床资料。根据内固定方式不同分为2组：髓内钉组29例(采用肱骨髓内钉系统固定)与锁定钢板组(采用肱骨近端锁定钢板系统固定) 32例。分析比较两组围手术期、随访及影像学资料。结果：髓内钉组和锁定钢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。髓内钉组手术时间、切口长度、术中出血量均显著优于锁定钢板组(P < 0.05)。所有患者术后获12~18个月随访，两组随访时间差异无统计学意义(t = −1.582, P = 0.114)。术后第2天至术后3个月，髓内钉组肱骨颈干角差值(3.28 ± 1.98)˚显著小于锁定钢板组(7.25 ± 3.22)˚，差异有统计学意义(t= −4.634, P < 0.001)。术后3个月髓内钉组VAS评分、Constant-Murley评分、DASH评分均显著优于锁定钢板组，差异有统计学意义(P < 0.05)。末次随访时，两组VAS评分、Constant-Murley评分、DASH评分及肩前屈上举ROM比较，差异均无统计学意义(P > 0.05)。髓内钉组不良反应发生率(6.90%, 2/29)显著低于锁定钢板组(28.13%, 9/32)，差异有统计学意义(P < 0.05)。结论：与锁定钢板治疗相比，髓内钉治疗老年肱骨近端Neer二、三部分骨折更符合骨科加速康复理念，具有手术创伤小、手术时间短、内固定牢靠、手术相关不良反应发生率低等特点，可有效缓解患者术后早期疼痛，有利于改善肩关节功能，促进患者加速康复。

Abstract: Objective: To compare the clinical effects of the intramedullary nail and locking plate in the treat-ment of Neer two- and three-part fractures of the proximal humerus in the elderly. Methods: A ret-rospective study was performed on 61 elderly patients with Neer two- and three-part fractures of the proximal humerus who had been operatively treated at the Department of Orthopedic Surgery and Sports Medicine, Affiliated Hospital of the University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital) from January 2018 to June 2021. Of them, 29 were fixated by humeral interlocking intramedullary nails and 32 by proximal humeral locking compression plates. The documents concerning the perioperative period, follow-up, and radiographs were analyzed and compared between the two groups. Results: The differences between the general preoperative data of patients in the intramedullary nail and locking plate groups were not statistically significant (P > 0.05) and were comparable. The operating time, incision length, and intraoperative bleeding were significantly better in the intramedullary nail group than in the locking plate group (P < 0.05). All patients followed up for 12 to 18 months after surgery, and the difference in follow-up time between the two groups was not statistically significantly different (t = −1.582, P = 0.114). From postopera-tive day 2 to 3 months, the difference in humeral neck-shaft angle was significantly smaller in the intramedullary nail group (3.28 ± 1.98)˚ than in the locking plate group (7.25 ± 3.22)˚, with a statis-tically significant difference (t = −4.634, P < 0.001). The VAS score, Constant-Murley score, and DASH score were significantly better in the intramedullary nail group than in the locking plate group at 3 months postoperatively, with statistically significant differences (P < 0.05). At the final follow-up, the differences in VAS score, Constant-Murley score, DASH score, and ROM between the two groups were not statistically significant (P > 0.05). The incidence of adverse reactions in the intramedullary nail group (6.90%, 2/29) was significantly lower than that in the locking plate group (28.13%, 9/32), and the difference was statistically significant (P < 0.05). Conclusion: Compared with the locking plate, the intramedullary nail is more consistent with the concepts in orthopaedic enhanced recovery after surgery for the treatment of two- and three-part fractures of the proximal humerus in the elderly, and is characterized by less surgical trauma, shorter operative time, secure internal fixation, and low incidence of surgery-related adverse reactions, which can effectively relieve pa-tients’ early postoperative pain, help improve shoulder joint function and promote patients’ accel-erated rehabilitation.