[1]金鹏宇,史景超,黄宁,等.Multiloc髓内钉内固定与锁定接骨板内固定治疗肱骨近端骨折的比较研究[J].中医正骨,2021,33(06):6-10.
　JIN Pengyu,SHI Jingchao,HUANG Ning,et al.A comparative study of internal fixation with Multiloc intramedullary nail versus locking plate for treatment of proximal humeral fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(06):6-10.
点击复制

Multiloc髓内钉内固定与锁定接骨板内固定治疗肱骨近端骨折的比较研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年06期
页码:
6-10
栏目:
临床研究
出版日期:
2021-06-20

文章信息/Info

Title:
A comparative study of internal fixation with Multiloc intramedullary nail versus locking plate for treatment of proximal humeral fractures
作者:
金鹏宇; 史景超; 黄宁; 张磊
象山县中医医院医疗健康集团,浙江 象山 315700
Author(s):
JIN Pengyu; SHI Jingchao; HUANG Ning; ZHANG Lei
Medical and Health Group of Xiangshan Hospital of Traditional Chinese Medicine,Xiangshan 315700,Zhejiang,China
关键词:
肩骨折;  肱骨骨折;  骨折固定术; 内;  髓内钉;  锁定接骨板;  临床试验
Keywords:
shoulder fractures;  humeral fractures;  fracture fixation; internal;  intramedullary nail;  locking plate;  clinical trial
摘要:
目的:比较Multiloc髓内钉内固定与锁定接骨板内固定治疗肱骨近端骨折的临床疗效和安全性。方法:回顾性分析58例肱骨近端骨折患者的病例资料,其中采用Multiloc髓内钉内固定治疗34例(髓内钉内固定组),采用锁定接骨板内固定治疗24例(接骨板内固定组)。比较2组患者的手术时间、术中出血量、住院时间、肩部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Constant-Murley肩关节评分及并发症发生率。结果:①一般指标。髓内钉内固定组患者的手术时间和住院时间均短于接骨板内固定组[(79.84±14.28)min,(108.74±22.17)min,t=6.726,P=0.003;(6.94±2.47)d,(12.78±3.18)d,t=9.732,P=0.000],髓内钉内固定组患者的术中出血量少于接骨板内固定组[(73.66±14.27)mL,(128.84±17.49)mL,t=8.783,P=0.000]。②肩部疼痛VAS评分。术前2组患者肩部疼痛VAS评分比较,差异无统计学意义[(8.85±1.43)分,(8.42±0.87)分,t=0.521,P=0.641]; 术后6个月,2组患者肩部疼痛VAS评分均低于术前(t=8.784,P=0.000; t=7.281,P=0.002),髓内钉内固定组患者肩部疼痛VAS评分低于接骨板内固定组[(3.24±0.43)分,(4.64±0.71)分,t=8.533,P=0.000]。③Constant-Murley肩关节评分。术前2组患者Constant-Murley肩关节评分比较,差异无统计学意义[(55.06±9.37)分,(54.44±9.27)分,t=0.974,P=0.558]; 术后6个月,2组患者Constant-Murley肩关节评分均高于术前(t=12.673,P=0.000; t=11.784,P=0.000),髓内钉内固定组患者Constant-Murley肩关节评分高于接骨板内固定组[(83.37±4.84)分,(71.64±5.37)分,t=0.308,P=0.013]。④并发症发生率。髓内钉内固定组1例发生肩峰撞击征,接骨板内固定组3例发生螺钉松动、2例发生肩峰撞击征; 髓内钉内固定组患者的并发症发生率低于接骨板内固定组(χ2=4.344,P=0.037)。结论:Multiloc髓内钉内固定治疗肱骨近端骨折,与锁定接骨板内固定相比,手术时间短、术中出血量少,能更好地缓解肩部疼痛、改善肩关节功能,且安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of internal fixation with Multiloc intramedullary nail(IMN)versus locking plate(LP)in treatment of proximal humeral fractures.Methods:The medical records of 58 patients with proximal humeral fractures were analyzed retrospectively.Thirty-four patients were treated with Multiloc IMN internal fixation(IMN internal fixation group),while the others with LP internal fixation(LP internal fixation group).The operative time,intraoperative blood loss,hospital stays,shoulder pain visual analogue scale(VAS)scores,Constant-Murley shoulder scores and complication incidence were compared between the 2 groups.Results:The operative time and hospital stays were shorter,and the intraoperative blood loss was less in IMN internal fixation group compared to LP internal fixation group(79.84±14.28 vs 108.74±22.17 minutes,t=6.726,P=0.003; 6.94±2.47 vs 12.78±3.18 days,t=9.732,P=0.000; 73.66±14.27 vs 128.84±17.49 mL,t=8.783,P=0.000).There was no statistical difference in shoulder pain VAS scores between the 2 groups before the surgery(8.85±1.43 vs 8.42±0.87 points,t=0.521,P=0.641).The shoulder pain VAS scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=8.784,P=0.000; t=7.281,P=0.002),and were lower in IMN internal fixation group compared to LP internal fixation group(3.24±0.43 vs 4.64±0.71 points,t=8.533,P=0.000).There was no statistical difference in Constant-Murley shoulder scores between the 2 groups before the surgery(55.06±9.37 vs 54.44±9.27 points,t=0.974,P=0.558).The Constant-Murley shoulder scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=12.673,P=0.000; t=11.784,P=0.000),and were higher in IMN internal fixation group compared to LP internal fixation group(83.37±4.84 vs 71.64±5.37 points,t=0.308,P=0.013).The acromion impingement syndrome was found in 1 patient in IMN internal fixation group and 2 patients in LP internal fixation group,moreover,screw loosening was found in 3 patients in LP internal fixation group.The postoperative complication incidence rate was lower in IMN internal fixation group compared to LP internal fixation group(χ2=4.344,P=0.037).Conclusion:Multiloc IMN internal fixation has such advantages as shorter operative time and less intraoperative blood loss,and it can better relieve shoulder pain and improve shoulder function compared to LP internal fixation in treatment of proximal humeral fractures,and it exhibits high safety.

参考文献/References:

[1] KING P R,IKRAM A,EKEN M M,et al.The effectiveness of a flexible locked intramedullary nail and an anatomically contoured locked plate to treat clavicular shaft fractures:a 1-year randomized controlled trial[J].J Bone Joint Surg Am,2019,101(7):628-634.
[2] LI M,WANG Y H,ZHANG Y P,et al.Intramedullary nail versus locking plate for treatment of proximal humeral fractures:a meta-analysis based on 1384 individuals[J].J Int Med Res,2018,46(11):4363-4376.
[3] 秦耕,周君琳.Multiloc髓内钉治疗肱骨近端骨折的临床疗效分析[J].中华肩肘外科电子杂志,2019,7(4):314-318.
[4] SONG H,WANG M M,DU H Y,et al.Comparison of locking plates and intramedullary nails in treatment of three-part or four-part proximal humeral neck fractures in elderly population:a randomized trial protocol[J].Medicine(Baltimore),2020,99(46):e22914.
[5] ZHANG H J,WANG S,DONG Y H,et al.Successful management of lower limb nonunion using locking plates and bone graft with retention of intramedullary nail[J/OL].Medicine(Baltimore),2019,98(13)[2020-11-12].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6455660/.
[6] LI M,WANG Y H,ZHANG Y P,et al.Intramedullary nail versus locking plate for treatment of proximal humeral fractures:a meta-analysis based on 1384 individuals[J].J Int Med Res,2018,46(11):4363-4376.
[7] 赵东升,郑晓勇,余清文,等.Multiloc髓内针治疗老年肱骨近端骨折的临床疗效[J].实用骨科杂志,2017,23(5):453-455.
[8] 张世民,李海丰,黄轶刚.骨折分类与功能评定[M].北京:人民军医出版社.2008:112-114.
[9] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005.
[10] MAREDZA M,PETROU S,DRITSAKI M,et al.Infographic:economic justification for intramedullary nail fixation over locking plate fixation for extra-articular distal tibial fractures[J].Bone Joint J,2018,100-B(5):622-623.
[11] 张伟,逸弘,崔胜宇,等.Multiloc髓内钉内固定治疗Neer二、三部分肱骨近端骨折的疗效分析[J].中国骨与关节损伤杂志,2018,33(7):693-696.
[12] DENG X Y,FAN Z Y,YU B F,et al.Use of a locking intra-medullary nail for the treatment of initial varus proximal humeral fracture:a prospective pilot study[J/OL].J Int Med Res,2020,48(6)[2020-10-09].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323304/.
[13] TUCKER S M,WEE H,FOX E,et al.Parametric finite element analysis of intramedullary nail fixation of proximal femur fractures[J].J Orthop Res,2019,37(11):2358-2366.
[14] 张伟,范建波,崔志明,等.MultiLoc髓内钉与PHILOS钢板治疗肱骨近端骨折的早期疗效比较[J].中国骨与关节杂志,2018,7(11):811-815.
[15] WEN H J,ZHU S Y,LI C Z,et al.Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures:an update meta-analysis[J].Medicine(Baltimore),2019,98(46):e17952.
[16] 翁建东,周鹏鹤.肩关节外侧入路与胸大肌三角肌入路锁定加压接骨板内固定治疗老年肱骨近端骨折的对比研究[J].中医正骨,2020,32(6):22-26.
[17] LEE W Y,PARK J Y,CHUN Y M.Operative treatment of 2-part surgical neck fracture of the humerus:intramedullary nail versus locking compression plate with technical conside-ration[J].J Orthop Trauma,2017,31(9):e270-e274.
[18] 孙国伟.锁定钢板与髓内钉治疗肱骨近端骨折的临床应用价值比较[J].中国医药指南,2019,17(23):35.
[19] 封挺,李军,陈梓峰,等.MultiLoc髓内钉与PHILOS钢板治疗肱骨近端骨折的疗效对比研究[J].创伤外科杂志,2020,22(7):513-516.
[20] 王岩松,褚鑫,孙毓,等.应用Multiloc髓内钉与Phlios钢板治疗老年肱骨近端骨折的疗效对比[J].锦州医科大学学报,2020,41(5):49-53.
[21] 岳肖华,李晏乐,王佩,等.髓内钉与锁定钢板治疗肱骨近端骨折临床疗效的Meta分析[J].中国中西医结合外科杂志,2020,26(5):980-985.
[22] 蒙敏峰,陈茂峰,王玉乐,等.老年肱骨近端骨折分型和治疗的研究进展[J].中医正骨,2020,32(11):33-36.
[23] 梁永辉,李永军,顾锋,等.锁定钢板结合微创钢板接骨技术和髓内钉固定治疗老年肱骨近端骨折的疗效比较[J].中华老年多器官疾病杂志,2020,19(7):499-503.

相似文献/References:

[1]刘磊,万春友,全先辉,等.锁定钢板内固定结合肱骨头植骨重建治疗 肱骨近端Neer三、四部分骨折[J].中医正骨,2015,27(10):52.
[2]任维龙,李刚,许波,等.骨原发性非霍奇金淋巴瘤1例[J].中医正骨,2015,27(02):73.
[3]江涛,史俊德,梁梯.江林主任医师运用自制弹性牵引器械治疗四肢创伤的经验总结[J].中医正骨,2016,28(05):70.
[4]蒋拥军,李克军,陈佳旭,等.荣肌揉筋手法治疗成人肱骨髁间骨折术后肘关节僵硬[J].中医正骨,2016,28(06):21.
　JIANG Yongjun,LI Kejun,CHEN Jiaxu,et al.Rongji Roujin(荣肌揉筋)manipulation for treatment of postoperative elbow joint stiffness in adults with humeral intercondylar fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(06):21.
[5]胡和军,吴法强,邓雄伟,等.骨皮质切剥术联合生龙接骨胶囊口服治疗四肢长骨干骨折不愈合[J].中医正骨,2016,28(10):64.
[6]王冲,宁凡友.解剖锁定加压钢板内固定联合自体髂骨板植骨治疗肱骨干骨折不愈合[J].中医正骨,2017,29(02):62.
[7]姜献,周红云,许超,等.肱骨近端骨折钢板内固定术后常见并发症的研究进展[J].中医正骨,2018,30(05):34.
[8]张小白,罗漫丽.应用动静平衡原则指导儿童肱骨髁上骨折术后功能锻炼[J].中医正骨,2019,31(07):77.
[9]曹慎,曹谦,汤智,等.杨氏手法复位环形垫超肘夹板“8”字固定治疗儿童移位型肱骨外髁骨折的临床研究[J].中医正骨,2019,31(11):1.
　CAO Shen,CAO Qian,TANG Zhi,et al.A clinical study of Yang's manipulative reduction combined with figure-of-eight fixation with ring-shaped pads and transarticular splints for treatment of displaced humeral lateral condyle fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(06):1.
[10]刘鸿豪,赵云昌,赵春节.闭合复位改良外侧交叉克氏针内固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床研究[J].中医正骨,2019,31(11):7.
　LIU Honghao,ZHAO Yunchang,ZHAO Chunjie.A clinical study of closed reduction and modified lateral cross Kirschner wire internal fixation for treatment of Gartland typeⅡandⅢhumeral supracondylar fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(06):7.
[11]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
　XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):11.
[12]盛红枫,张玉柱.微创锁定钢板内固定配合中药内服治疗肱骨近端骨折[J].中医正骨,2015,27(04):49.
[13]孙鹏,谭磊,阎乾,等.人工肱骨头置换术治疗老年肱骨近端Neer三、四部分骨折[J].中医正骨,2016,28(05):43.
[14]方 铭.“T”形双切口锁定钢板内固定治疗老年肱骨近端骨折[J].中医正骨,2016,28(05):46.
[15]张国文.肱骨近端锁定接骨板内固定治疗肱骨近端骨折[J].中医正骨,2016,28(08):50.
[16]贾柯,徐克武,胡翔.老年肱骨近端骨折分型及临床治疗进展[J].中医正骨,2017,29(03):24.
[17]柴浩,张磊,孙荣鑫.半关节成形术和反式肩关节置换术治疗老年肱骨近端Neer三、四部分骨折的对比研究[J].中医正骨,2017,29(07):21.
　CHAI Hao,ZHANG Lei,SUN Rongxin.A comparative study of hemiarthroplasty versus reverse shoulder arthroplasty for treatment of Neer 3-part and 4-part proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):21.
[18]姚华海,孙龙泰,崔龙慷,等.肩峰下前外侧入路与胸大肌三角肌入路锁定钢板内固定治疗老年肱骨近端二、三部分骨折的对比研究[J].中医正骨,2017,29(09):1.
　YAO Huahai,SUN Longtai,CUI Longkang,et al.A comparative study of locking plate internal fixation through subacromial anterolateral approach versus ectopectoralis-deltoid approach for treatment of Neer 2-part and 3-part proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):1.
[19]刘丹琼.手法复位杉树皮夹板固定联合补肾活血汤口服 治疗老年肱骨近端骨折肾虚血瘀证的临床研究[J].中医正骨,2018,30(08):16.
　LIU Danqiong.A clinical study of manipulative reduction and fir-bark splint external fixation combined with oral application of Bushen Huoxue Tang(补肾活血汤)for treatment of kidney-deficiency-blood-stasis-type proximal humeral fractures in the aged LIU Danqiong[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(06):16.
[20]刘凯,尚如国,梁志超,等.老年肱骨近端骨折后肩关节功能恢复的影响因素分析[J].中医正骨,2018,30(09):39.
　LIU Kai,SHANG Ruguo,LIANG Zhichao,et al.Analysis of factors influencing shoulder function recovery after proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(06):39.

更新日期/Last Update: 2021-12-20