实用老年医学

实用老年医学 ›› 2024, Vol. 38 ›› Issue (1): 40-43.doi: 10.3969/j.issn.1003-9198.2024.01.010

• 临床研究 • 上一篇    下一篇

髓内复位与撬拨复位结合锁定钢板治疗复杂老年肱骨近端骨折的疗效比较

赵鑫, 严俊伟, 尹昭伟, 史陈, 潘少蔚, 顾延庆, 徐晨阳, 杨翁勃, 王啸, 梁斌   

  1. 210006 江苏省南京市,南京医科大学附属南京医院(南京市第一医院)骨科(赵鑫,严俊伟,尹昭伟,史陈,潘少蔚,顾延庆,徐晨阳,杨翁勃,梁斌);210046 江苏省南京市,南京市栖霞区医院骨科(王啸)
  • 收稿日期:2023-02-21 发布日期:2024-01-19
  • 通讯作者: 梁斌,Email:ib15366110173@163.com
  • 基金资助:
    江苏省中医药科技发展计划项目(YB201939);南京市卫生科技发展专项资金重点项目(ZKX19024);南京医科大学-西脉临床研究基金资助项目(2022-A-0029)

Comparison of intramedullary reduction technique and leverage reduction technique combined with locking plate in the treatment of complex proximal humeral fractures in elderly

ZHAO Xin, YAN Junwei, YIN Zhaowei, SHI Chen, PAN Shaowei, GU Yanqing, XU Chenyang, YANG Wengbo, WANG Xiao, LIANG Bin   

  1. Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China (ZHAO Xin, YAN Junwei, YIN Zhaowei, SHI Chen, PAN Shaowei, GU Yanqing, XU Chenyang, YANG Wengbo, LIANG Bin); Department of Orthopaedics, Nanjing Qixia District Hospital, Nanjing 210046, China(WANG Xiao)
  • Received:2023-02-21 Published:2024-01-19
  • Contact: LIANG Bin, Email: ib15366110173@163.com

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摘要： 目的 比较髓内复位技术与撬拨复位技术结合锁定钢板治疗复杂老年肱骨近端骨折的疗效。 方法 选取2020年9月至2022年9月在我院就诊的肱骨近端骨折病人,采用随机数表法分为A组(撬拨复位组)与B组(髓内复位组),每组各24例。记录并比较2组手术时间、透视时间,术后3 d、12个月时的影像学指标、Constant-Murley肩关节功能评分与VAS评分,术后12个月复位丢失发生情况。 结果 B组的手术时间、透视时间均短于A组(P＜0.05或P＜0.01)。2组术后3 d、12个月时的颈干角及肱骨头高度差异均无统计学意义(P＞0.05),但A组颈干角丢失量及肱骨头高度丢失量大于B组,差异均有统计学意义(P＜0.05)。术后12个月,2组VAS、Constant-Murley肩关节功能评分均较术后3 d显著改善,且B组的Constant-Murley肩关节功能评分高于A组,VAS评分低于A组,差异均有统计学意义(P＜0.05)。B组复位丢失率显著低于A组(4.2%比33.3%,P＜0.05)。 结论 髓内复位技术治疗老年骨质疏松肱骨近端骨折可以缩短手术时间,减少病人及医护人员在射线下的暴露时间,同时,可以提高肱骨距的复位质量,降低术后发生复位丢失的风险,改善术后肩关节功能。

关键词: 老年人, 肱骨近端骨折, 切开复位内固定, 复位技术

Abstract: Objective To compare the efficacy of intramedullary reduction technique and leverage reduction technique combined with locking plate in the treatment of elderly patients with complex proximal humeral fractures. Methods The patients with proximal humeral fracture treated in our hospital from September 2020 to September 2022 were selected and divided into group A (receiving leverage reduction) and group B (receiving intramedullary reduction) by random number table method, with 24 cases in each group. The operation time, fluoroscopy time, the imaging indicators, Constant-Murley score and visual analogue scale (VAS) score 3 days and 12 months after surgery, and the incidence of reduction loss 12 months after surgery were recorded and compared between the two groups. Results The operative time and fluoroscopy time in group B were shorter than those in group A (P<0.05 or P<0.01).There were no statistically significant differences in humeral head-shaft angle and humeral head height between the two groups 3 days and 12 months after surgery (P>0.05), but the loss of humeral head-shaft angle and humeral head height in group A were greater than those in group B (P<0.05). Compared with 3 days after surgery, the scores of VAS and Constant-Murley in both groups were significantly improved 12 months after surgery, and especially in group B (all P<0.05).The reduction loss rate in group B was significantly lower than that in group A (4.2% vs 33.3%, P<0.05). Conclusions Intramedullary reduction technique for the treatment of proximal humeral fractures in aged osteoporotic patients can shorten the operative time, reduce the exposure time of patients and medical staff to radiation, improve the reduction quality of humeral calcar, reduce the risk of postoperative reduction loss, and improve the postoperative shoulder joint function.

Key words: aged, proximal humeral fractures, open reduction and internal fixation, reduction technique

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