【摘要】 目的分析闭合复位髓内钉内固定治疗老年肱骨外科颈骨折的可行性。方法回顾性分析2016年1月—2019年1月四川省达州市中心医院骨科收治的92例老年肱骨外科颈骨折患者的临床资料,其中男性51例,女性41例;年龄60～82岁,平均70. 5岁;道路交通伤37例,砸伤32例,摔伤23例。根据手术方式不同分为锁定钢板组(n=45)和髓内钉组(n=47),其中锁定钢板组予以锁定钢板切开内固定治疗,髓内钉组予以闭合性复位髓内钉治疗,比较两组患者围术期指标情况及关节活动度情况,优良率、术后并发症发生情况。结果髓内钉组术中出血量(92. 07±15. 83) m L少于锁定钢板组(154. 85±20. 96) m L,手术时间(76. 3±4. 3) min、切口长度(7. 59±1. 32) cm、骨折愈合时间(8. 2±0. 8)周均短于锁定钢板组(99. 3±5. 8) min、(14. 63±1. 48) cm、(13. 6±0. 9)周,比较差异有统计学意义(P <0. 05)。锁定钢板组患者关节前屈(143. 12±10. 49)°、内旋(92. 87±6. 79)°、内收(106. 40±9. 26)°、后伸(51. 30±6. 55)°、外展(106. 27±8. 16)°、外旋(62. 18±8. 67)°活动度与髓内钉组[(142. 09±11. 47)°、(91. 93±8. 17)°、(107. 11±8. 92)°、(52. 37±5. 42)°、(108. 68±9. 08)°、(64. 65±7. 52)°]比较差异无统计学意义(P> 0. 05)。锁定钢板组和髓内钉组优良率(73%vs. 81%)比较差异无统计学意义(P>0. 05)。锁定钢板组与髓内钉组并发症总发生率(17%vs.14%)比较差异无统计学意义(P> 0. 05)。结论锁定钢板切开内固定和闭合复位髓内钉内固定治疗老年肱骨外科颈骨折患者疗效相当,闭合复位髓内钉内固定治疗还具有创伤小、手术时间短、愈合快、出血量少等优势。更多还原

【Abstract】 Objective To analyze the feasibility of closed reduction and intramedullary nail in the treatment of surgical neck fracture of humerus in the elderly. Methods The clinical data of 92 elderly patients with surgical neck fracture of humerus were retrospectively analyzed,who were admitted into Department of Orthopaedics,Dazhou Central Hospital from Jan. 2016 to Jan. 2019. There were 51 males and 41 females,with an average age of70. 5 years( range,59-82 years). There were 37 cases of traffic accident injuries,32 cases of smashing injuries and23 cases of falling injuries. According to the different operation methods,patients were divided into locking plate group( n = 45) and intramedullary nail group( n = 47). Locking plate group was treated with locking plate open internal fixation and intramedullary nail group was treated with closed reduction and intramedullary nail. The excellent and good rate,postoperative complications,perioperative indexes and joint activity of the two groups were compared.Results There was no significant difference in the excellent and good rate between locking plate group( 73%) and intramedullary nail group( 81%,P > 0. 05). The amount of bleeding in the intramedullary nail group was( 92. 07 ±15. 83) m L,which was less than that in the locking plate group( 154. 85 ± 20. 96) m L; the operation time( 76. 3 ±4. 3) min,incision length( 7. 59 ± 1. 32) cm and fracture healing time( 8. 2 ± 0. 8) weeks in the intramedullary nail group were shorter than those in the locking plate group[( 99. 3 ± 5. 8) min,( 14. 63 ± 1. 48) cm,( 13. 6 ± 0. 9)weeks],with statistical differences( P < 0. 05). There was no significant difference in terms of joint flexion,pronation,adduction,extension,abduction,pronation between the locking plate group [( 143. 12 ± 10. 49) °,( 92. 87 ±6. 79) °,( 106. 40 ± 9. 26) °,( 51. 30 ± 6. 55) °,( 106. 27 ± 8. 16) °,( 62. 18 ± 8. 67) °] and the intramedullary nail group [( 142. 09 ± 11. 47) °,( 91. 93 ± 8. 17) °,( 107. 11 ± 8. 92) °,( 52. 37 ± 5. 42) °,( 108. 68 ± 9. 08) °,( 64. 65± 7. 52) °,P > 0. 05. There was no significant difference in the total incidence of complications between locking plate group( 17%) and intramedullary nail group( 14%,P > 0. 05). Conclusion Locking plate open internal fixation and closed reduction and intramedullary nail internal fixation in the treatment of elderly patients with humeral surgical neck fracture can obtain similar curative effects. Meanwhile,closed reduction and intramedullary nail fixation treatment have advantages such as small trauma,short operation time,fast healing,and little blood loss.更多还原