【摘要】 目的 比较直型和弯型髓内钉固定治疗肱骨近端骨折的临床疗效。方法 根据髓内钉类型不同将69例肱骨近端骨折患者分为弯钉组(采用钛合金第2代肱骨髓内钉系统固定治疗，24例)和直钉组(采用多维锁定肱骨近端髓内钉系统固定治疗，45例)。比较两组手术情况、骨折复位及愈合情况、肩关节活动度、Constant-Murley评分。结果 患者均获得随访，时间12～38(16.8±11.3)个月。骨折均复位良好。术中出血量两组比较差异无统计学意义(P>0.05),手术时间弯钉组短于直钉组(P<0.01)。除直钉组2例骨折不愈合外，其余患者术后4～6周骨痂开始生长，术后3个月骨折愈合。术后12个月Constant-Murley评分直钉组高于弯钉组(P<0.05)。末次随访时，两组患侧肩关节外展75°～90°,前屈上举120°～180°,外展上举110°～180°,内旋80°～90°,外旋30°～45°。结论 两种髓内钉固定治疗肱骨近端骨折均能获得良好疗效，弯型髓内钉手术时间更少，直型髓内钉术后功能恢复更优。更多还原

【Abstract】 Objective To compare the clinical effect of straight and curved intramedullary nail fixation on proximal humerus fracture.Methods According to different types of intramedullary nails, 69 patients with proximal humerus fractures were divided into curved nail group(24 cases were treated with titanium alloy second generation humeral intramedullary nail fixation system) and straight nail group(45 cases were treated with multidimensional locking proximal humerus intramedullary fixation system).The operative status, fracture reduction and healing, shoulder range of motion and Constant-Murley score were compared between the two groups. Results All patients were followed up for 12～38(16.8±11.3) months.All fractures were reduced well.There was no statistical difference in intraoperative blood loss between the two groups(P>0.05),and the operative time in the curved nail group was shorter than that in the straight nail group(P<0.01).Except for 2 cases of nonunion in the straight nail group, the callus in other patients began to grow within 4～6 weeks after surgery, and the fractures healed within 3 months after surgery.At 12 months after surgery, the Constant-Murley score was higher in the straight nail group than that in the curved nail group(P<0.05).At the last follow-up, the affected shoulder joint of the two groups was abduction with 75°～90°,anteflexion and upward lifting with 120°～180°,abduction and upward lifting 110°～180°,internal rotation with 80°～90°,and external rotation with 30°～45°.Conclusions In the treatment of proximal humerus fractures, both types of intramedullary nail can achieve good results, the operation time of curved nail is less, the function recovery of straight nail is better.更多还原