Multiloc髓内钉与锁定钢板治疗老年肱骨外科颈骨折的临床研究
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摘要
目的探讨Multiloc髓内钉与肱骨近端锁定钢板治疗NeerⅡ型老年肱骨外科颈骨折的疗效。方法回顾性研究自2016年6月至2018年6月收治的30例NeerⅡ型老年肱骨外科颈骨折,男5例,女25例;年龄54～88岁,平均(72.3±12.7)岁。其中10例行肱骨Multiloc髓内钉固定,20例行锁定钢板(PHILOS组)固定。比较两组患者的手术时间、切口长度、术中出血量、视觉模拟评分(visual analogue scale,VAS)、Constant-Murley肩关节功能评分。结果两组患者均获随访,Multiloc髓内钉组随访时间为0.9～1.8年,平均1.3年;PHILOS组为1.1～2.1年,平均1.5年。两组的手术时间、切口长度、术中出血量、视觉模拟评分(visual analogue scale,VAS)、Constant-Murley肩关节功能评分比较,差异无统计学意义(P>0.05)。与锁定钢板组比较,Multiloc髓内钉组术后第1天颈干角更大,差异有统计学意义(P<0.05)。结论 Multiloc髓内钉与肱骨近端锁定钢板治疗NeerⅡ型老年肱骨外科颈骨折临床疗效无差异。Multiloc髓内钉能够多枚锁定螺钉多方向、多维度固定肱骨骨折端,有效的控制肱骨骨折端的旋转,术后可早期进行康复功能锻炼,关节功能恢复良好。
Objective To explore the clinic effect of Multiloc PHN and PHILOS for the NeerⅡ humerus surgical neck fracture in the elderly retrospectively.Methods Thirty patients with NeerⅡhumerus surgical neck in the elderly from June 2016 to June 2018 were reviewed.There were 5 males and 25 females,aged 54～88 years,with an average age of(72.3±12.7)years.Ten patients were treated with Multiloc PHN,Twenty patients were treated with PHILOS.The operation time,incision length,intraoperative bleeding volume,visual analogue scale(VAS)and Constant-Murley shoulder function score were compared between the two groups.Results There was no significant ifference in the operation time,The follow-up time of Multiloc PHN was 0.9～1.8 years,with an average of 1.3 years,while that of PHILOS group was 1.1～2.1 years,with an average of 1.5 years.the length of the incision,perioperative blood loss,the VAS,the Constant score in the two groups(P>0.05).Compared with PHILOS,The neck stem angle on the first day after operation of the Multiloc PHN was larger,and the difference was statistically significant(P<0.05).ConclusionMultiloc PHN and PHILOS can get the same clinic outcomes for treatment of the NeerⅡ humerus surgical neck,Multiloc PHN can stabilize the proximal end of the humerus with multiple screws in multiple dimensions and directions,and control the rotation of fracture ends more effectively.Patients can make the function exercise early after operation,and the joint function can recover well.
Objective To explore the clinic effect of Multiloc PHN and PHILOS for the NeerⅡ humerus surgical neck fracture in the elderly retrospectively.Methods Thirty patients with NeerⅡhumerus surgical neck in the elderly from June 2016 to June 2018 were reviewed.There were 5 males and 25 females,aged 54～88 years,with an average age of(72.3±12.7)years.Ten patients were treated with Multiloc PHN,Twenty patients were treated with PHILOS.The operation time,incision length,intraoperative bleeding volume,visual analogue scale(VAS)and Constant-Murley shoulder function score were compared between the two groups.Results There was no significant ifference in the operation time,The follow-up time of Multiloc PHN was 0.9～1.8 years,with an average of 1.3 years,while that of PHILOS group was 1.1～2.1 years,with an average of 1.5 years.the length of the incision,perioperative blood loss,the VAS,the Constant score in the two groups(P>0.05).Compared with PHILOS,The neck stem angle on the first day after operation of the Multiloc PHN was larger,and the difference was statistically significant(P<0.05).ConclusionMultiloc PHN and PHILOS can get the same clinic outcomes for treatment of the NeerⅡ humerus surgical neck,Multiloc PHN can stabilize the proximal end of the humerus with multiple screws in multiple dimensions and directions,and control the rotation of fracture ends more effectively.Patients can make the function exercise early after operation,and the joint function can recover well.
引文
[1]孙培锋,宋展昭,夏国峰,等.肱骨近端锁定钢板治疗肱骨外科颈骨折不愈合的临床分析[J].中国骨与关节损伤杂志,2011,26(5):474-475.
[2]郭永红.经皮克氏针固定治疗肱骨外科颈骨折[J].实用骨科杂志,2010,16(12):925-926.
[3] Edwards SL,Wilson NA,Zhang LQ,et al.Two-part surgical neckfractures of the proximal part of the humerus.A biomechanical evaluation of two fixation techniques[J].J Bone Joint Surg(Am),2006,88(10):2258-2264.
[4] Foruria AM,Carrascal MT,Revilla C,et al.Proximal humerus fracture rotational stability after fixation using a locking plate or afixed-angle locked nail:the role of implant stiffness[J].Clinical Biomechanics,2010,25(4):307-311.
[5] Koukakis A,Apostolou CD,Taneja T,et al.Fixation of proximalhumerus fractures using the PHILOS plate:early experience[J].Clin Orthop Relat Res,2006(442):115-120.
[6]任世祥,林源,曲铁兵,等.交锁髓内钉治疗肱骨外科颈骨折的临床疗效[J].实用骨科杂志,2009,15(10):743-744.
[7]纪泉,文良元,薛庆云,等.肱骨近端锁定型钉板治疗老年人移位的肱骨近端骨折[J].中华老年医学杂志,2011,30(9):749-752.
[8] Nijs S,Meskens M,Hessmann MH.Proximal humerus fractures:inttramedullary nailing[J].Tech Orthop,2013,28(4):319-323.
[9] Horn J,Gueorguiev B,Brianza S,et al.Biomechanical evaluation of Two-Part surgical neck fractures of the humerus fixed by angular stable locked intramedullary nail[J].J Orthop Trauma,2011,25(7):406-413.
[10] Mittlmeier TW,Stedtfeld HW,Ewert A,et al.Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail(Targon PH)[J].J Bone Joint Surg(Am),2003,85(4):136-146.
[11] Rothstock S,Plecko M,Kloub M,et al.Bilmechanical evaluation of two intramedullary nailing techniques with different locking otions in a three-part fracture proximal humerus model[J].Clin Biomech,2012,27(7):686-691.
[12] Edwards SL,Wilson NA,Zhang LQ,et al.Two-part surgical neck fractures of the proximal part of the humerus,A biomechanical evaluation of two fixation techniques[J].J Bone Joint Surg(Am),2006,88(10):2258-2264.
[13] Hessmann MH,Hansen WS,Krummenauer F,et al.Locked plate fixation and intramedully nailing for proximal humerus fratures:a biomechanical evation[J].J Trauma,2005,58(6):1194-1201.
[14] Hessmann MH,Sterntein W,MEhler D,et al.Are angel fixed implants with elastic properties advantageous for the internal of proximal humerous fractures?[J].Biomed Tech(Berl),2004,49(12):345-350.
[15]钱臣.Philos钢板结合同种异体骨治疗骨质疏松性肱骨外科颈骨折[J].实用骨科杂志,2015,21(2):163-165.
[2]郭永红.经皮克氏针固定治疗肱骨外科颈骨折[J].实用骨科杂志,2010,16(12):925-926.
[3] Edwards SL,Wilson NA,Zhang LQ,et al.Two-part surgical neckfractures of the proximal part of the humerus.A biomechanical evaluation of two fixation techniques[J].J Bone Joint Surg(Am),2006,88(10):2258-2264.
[4] Foruria AM,Carrascal MT,Revilla C,et al.Proximal humerus fracture rotational stability after fixation using a locking plate or afixed-angle locked nail:the role of implant stiffness[J].Clinical Biomechanics,2010,25(4):307-311.
[5] Koukakis A,Apostolou CD,Taneja T,et al.Fixation of proximalhumerus fractures using the PHILOS plate:early experience[J].Clin Orthop Relat Res,2006(442):115-120.
[6]任世祥,林源,曲铁兵,等.交锁髓内钉治疗肱骨外科颈骨折的临床疗效[J].实用骨科杂志,2009,15(10):743-744.
[7]纪泉,文良元,薛庆云,等.肱骨近端锁定型钉板治疗老年人移位的肱骨近端骨折[J].中华老年医学杂志,2011,30(9):749-752.
[8] Nijs S,Meskens M,Hessmann MH.Proximal humerus fractures:inttramedullary nailing[J].Tech Orthop,2013,28(4):319-323.
[9] Horn J,Gueorguiev B,Brianza S,et al.Biomechanical evaluation of Two-Part surgical neck fractures of the humerus fixed by angular stable locked intramedullary nail[J].J Orthop Trauma,2011,25(7):406-413.
[10] Mittlmeier TW,Stedtfeld HW,Ewert A,et al.Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail(Targon PH)[J].J Bone Joint Surg(Am),2003,85(4):136-146.
[11] Rothstock S,Plecko M,Kloub M,et al.Bilmechanical evaluation of two intramedullary nailing techniques with different locking otions in a three-part fracture proximal humerus model[J].Clin Biomech,2012,27(7):686-691.
[12] Edwards SL,Wilson NA,Zhang LQ,et al.Two-part surgical neck fractures of the proximal part of the humerus,A biomechanical evaluation of two fixation techniques[J].J Bone Joint Surg(Am),2006,88(10):2258-2264.
[13] Hessmann MH,Hansen WS,Krummenauer F,et al.Locked plate fixation and intramedully nailing for proximal humerus fratures:a biomechanical evation[J].J Trauma,2005,58(6):1194-1201.
[14] Hessmann MH,Sterntein W,MEhler D,et al.Are angel fixed implants with elastic properties advantageous for the internal of proximal humerous fractures?[J].Biomed Tech(Berl),2004,49(12):345-350.
[15]钱臣.Philos钢板结合同种异体骨治疗骨质疏松性肱骨外科颈骨折[J].实用骨科杂志,2015,21(2):163-165.