【摘要】 [目的]比较髓内钉与锁定板固定肱近端四部分骨折的临床疗效。[方法]回顾性分析2021年1月—2023年6月手术治疗的25例肱骨近端四部分骨折患者的临床资料，根据术前医患沟通结果，13例采用髓内钉治疗（髓内钉组），12例采用锁定板治疗（锁定板组）。比较两组围手术期、随访及影像学资料。[结果]两组均顺利完成手术，术中未发生严重并发症。髓内钉组手术时间[(89.2±9.3) min vs(120.0±12.5) min, P<0.001]、切口总长度[(7.3±1.0) cm vs(13.5±1.1) cm, P<0.001]、术中失血量[(225.2±13.6) mL vs(300.1±15.0) mL, P<0.001]、术后引流量[(37.3±14.86) m L vs(53.0±15.7) mL, P=0.017]、主动活动时间[(2.3±0.7) d vs(3.0±0.8) d, P=0.042]均显著优于锁定板组。两组患者均获12个月随访，髓内钉组完全负重活动时间[(11.5±1.2)周vs(13.6±1.7)周, P=0.002]显著早于锁定板组。随时间推移，两组患者VAS、ASES、Constant-Murley评分及肩关节前屈上举、外展上举ROM均显著改善（P<0.05），术后第1 d，髓内钉组VAS评分[(6.0±1.1) vs(7.5±1.2), P=0.003]显著优于锁定板组。术后3个月时髓内钉组的ASES评分[(71.1±4.5) vs(66.9±3.6), P=0.017]、Constant-Murley评分[(68.4±5.2) vs(61.0±3.5), P<0.001]、肩关节前屈ROM[(118.9±17.5)°vs(105.2±12.2)°, P=0.034]以及外展上举ROM[(115.8±16.5)°vs(102.4±13.2)°, P=0.036]均显著优于锁定板组。影像方面，两组骨折复位质量的差异无统计学意义（P>0.05），末次随访，髓内钉组肱骨颈干角（humeral neck-shaft angle, HNSA）[(131.9±2.3)°vs(129.6±2.9)°, P=0.038]显著大于锁定板组。髓内钉组骨折愈合时间显著早于锁定板组。[结论]髓内钉治疗肱骨近端四部分骨折，具有手术创伤小，固定稳定，骨折愈合快，利于早期康复等优势。更多还原

【Abstract】 [Objective] To compare the clinical efficacy of intramedullary nail versus locking plate in fixation of four-part proximal humeral fractures. [Methods] A retrospective study was conducted on 25 patients who had four-part proximal humeral fractures surgically treated from January 2021 to June 2023. According to the preoperative doctor-patient communication, 13 patients received intramedullary nail(the IN group), while other 12 patients underwent locking plate(the LP group). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were operated on successfully, with no serious complications occurred during the operation. The IN group proved significantly superior to the LP group in terms of operation time [(89.2±9.3) min vs(120.0±12.5) min, P<0.001],the total incision length [(7.3±1.0) cm vs 13.5±1.1) cm, P<0.001], intraoperative blood loss [(225.2±13.6) m L vs(300.1±15.0) mL, P<0.001],postoperative drainage [(37.3±14.9) mL vs(53.0±15.7) m L, P=0.017] and active activity time [(2.3±0.7) days vs(3.0±0.8) days, P=0.042]. All patients in both groups were followed up for more than 12 months, and the IN group resumed full weight-bearing activity significantly earlier than the LP group [(11.5±1.2) weeks vs(13.6±1.7) weeks, P=0.002]. The VAS, ASES and Constant-Murley scores, as well as shoulder flexion-elevation and abduction-elevation ROMs in both groups were significantly improved over time(P<0.05). The IN group was significantly better than the LP group in terms of VAS score [(6.0±1.1) vs(7.5±1.2), P=0.003] 1 day after operation, ASES score [(71.1±4.5) vs(66.9±3.6), P=0.017], Constant-Murley score [(68.4±5.2) vs(61.0±3.5), P<0.001], forward flexion-elevation ROM [(118.9±17.5)° vs(105.2±12.2)°, P=0.034), and the abduction-elevation ROM [(115.8±16.5)° vs(102.4±13.2)°, P=0.036] 3 months postoperatively. Regarding imaging, there was no significant difference in fracture reduction quality between the two groups(P>0.05). At the last follow-up, the IN group had significantly greater humeral neck-shaft angle(HNSA) than the LP group [(131.9±2.3)° vs(129.6±2.9)°, P=0.038], additionally, the former got fracture healing on images significantly earlier than the latter(P<0.005). [Conclusion] Intramedullary nail fixation of four-part proximal humerus fractures has the advantages of less surgical trauma, stable fixation, rapid fracture healing and early rehabilitation over the locking plate.更多还原