中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (36): 5782-5786.doi: 10.12307/2021.342

• 人工假体 artificial prosthesis • 上一篇    下一篇

髓内钉与半肩置换治疗内翻型肱骨近端骨折：回顾性非随机小样本优势分析

王庆伟1，王华松2，黄继锋2，石华峰1，胡寿勇1，谢  辉1   

  1. 1荆门市第一人民医院骨科，湖北省荆门市   448000；2解放军中部战区总医院骨科，湖北省武汉市   430070
  • 收稿日期:2021-02-25 修回日期:2021-02-26 接受日期:2021-03-31 出版日期:2021-12-28 发布日期:2021-09-17
  • 通讯作者: 王华松，博士，副主任医师，硕士生导师，解放军中部战区总医院骨科，湖北省武汉市 430070
  • 作者简介:王庆伟，男，1992年生，湖北省荆门市人，汉族，2018年湖北中医药大学毕业，硕士，医师，主要从事创伤骨科方面的研究。
  • 基金资助:
    荆门市科学技术研究与开发计划项目(2020YFYB085)，项目负责人：王庆伟

Intramedullary nail versus shoulder hemiarthroplasty for proximal humeral fractures with varus deformity: a retrospective non-random small-sample advantage analysis

Wang Qingwei1, Wang Huasong2, Huang Jifeng2, Shi Huafeng1, Hu Shouyong1, Xie Hui1   

  1. 1Department of Orthopedics, the First People’s Hospital of Jingmen, Jingmen 448000, Hubei Province, China; 2Department of Orthopedics, General Hospital of Central Theater Command, Wuhan 430070, Hubei Province, China
  • Received:2021-02-25 Revised:2021-02-26 Accepted:2021-03-31 Online:2021-12-28 Published:2021-09-17
  • Contact: Wang Huasong, MD, Associate chief physician, Master’s supervisor, Department of Orthopedics, General Hospital of Central Theater Command, Wuhan 430070, Hubei Province, China
  • About author:Wang Qingwei, Master, Physician, Department of Orthopedics, the First People’s Hospital of Jingmen, Jingmen 448000, Hubei Province, China
  • Supported by:
    Jingmen Municipal Science and Technology Research and Development Project, No. 2020YFYB085 (to WQW)

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摘要：


文题释义：

肱骨近端骨折：是创伤骨科常见疾病之一，约占全身骨折的5%，而且在老年病人和骨质疏松人群中比例有所提高，仅次于髋部及桡骨远端骨折。
内翻型肱骨近端骨折：是肱骨近端骨折中的一种特殊类型，指肱骨近端骨折时颈干角< 120°，肱骨头与肱骨干呈现内翻畸形，约占所有肱骨近端骨折的43%。近年来，因部分中远期随访发现内翻型肱骨近端骨折术后常出现内固定失败而逐渐得到重视，此次研究也重点关注这一特殊骨折类型。

背景：目前对于不稳定或者明显移位的内翻型肱骨近端骨折，临床上都倾向于早期手术治疗，主要包括内固定和关节置换两种方案，但对于老年骨质疏松患者具体的修复方案选择仍存有争议。
目的：比较髓内钉内固定与人工半肩关节置换治疗内翻型肱骨近端骨折的疗效。
方法：回顾性分析解放军中部战区总医院2016年1月至2019年1月采用髓内钉内固定和人工半肩关节置换治疗的54例内翻型肱骨近端骨折患者的病历资料，男22例，女32例。根据治疗方式的不同分成2组，髓内钉组35例，置换组19例。记录并比较两组患者手术时间、术中失血量、住院时间及末次随访时肩关节活动度、疼痛目测类比评分、Constant-Murley肩关节评分及并发症等情况。

结果与结论：①两组术前资料比较差异均无显著性意义(P > 0.05)，具有可比性；②髓内钉组手术时间(59.6±14.3) min明显短于置换组(95.7±17.2) min，差异有显著性意义(P < 0.05)；髓内钉组术中失血量(78.5±18.9) mL也较置换组(203.7±23.1) mL少，且差异有显著性意义(P < 0.05)；两组在住院时间、随访时间上差异无显著性意义(P > 0.05)；③髓内钉组末次随访时的肩关节活动度、Constant-Murley肩关节评分均优于置换组，差异有显著性意义(P < 0.05)；两组在末次随访疼痛目测类比评分、并发症等方面差异均无显著性意义(P > 0.05)；④提示对于内翻型肱骨近端骨折髓内钉内固定与人工半肩关节置换均为有效的治疗方式，但采用髓内钉内固定治疗内翻型肱骨近端骨折，其创伤小的同时肩关节功能恢复更有保障。

https://orcid.org/0000-0002-9618-7126 (王庆伟)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 肱骨近端骨折, 髓内钉, 内固定, 半肩关节置换, 内翻畸形

Abstract: ACKGROUND: Early surgical treatments, mainly including internal fixation and joint replacement, are favored for unstable or significantly displaced proximal humeral fractures in clinical practice. However, there is still a controversy on the specific regimen for elderly osteoporotic patients.  
OBJECTIVE: To compare the clinical outcomes of Trigen intramedullary nailing versus shoulder hemiarthroplasty for varus proximal humeral fractures.
METHODS:  A retrospective study was performed on 54 patients with varus proximal humerus fractures treated with intramedullary nailing or shoulder hemiarthroplasty in the General Hospital of Central Theater Command from January 2016 to January 2019. There were 22 males and 32 females. According to the different treatment methods, all the patients were divided into two groups: 35 patients in the intramedullary nail group and 19 patients in the shoulder hemiarthroplasty. Operation time, intraoperative blood loss, length of hospital stay and shoulder joint mobility, Visual Analogue Scale score, Constant-Murley shoulder joint score, and complications at the last follow-up were recorded and compared between two groups.  
RESULTS AND CONCLUSION: There was no significant difference in the preoperative data between the intramedullary nail group and the shoulder hemiarthroplasty group (P > 0.05), and they were comparable. The operation time of the intramedullary nail group [(59.6±14.3) minutes] was significantly shorter than that in the shoulder hemiarthroplasty group [(95.7±17.2) minutes] (P < 0.05). The intraoperative blood loss in the intramedullary nail group [(78.5±18.9) mL] was significantly lower than that in the shoulder hemiarthroplasty group [(203.7±23.1) mL] (P < 0.05). There were no significant differences in hospitalization time and follow-up time between the two groups (P > 0.05). The intramedullary nail group was superior to the shoulder hemiarthroplasty group in shoulder mobility and Constant-Murley shoulder joint score at the last follow-up, and the differences were statistically significant (P < 0.05). There were no significant differences in Visual Analogue Scale score and complications at the last follow-up between the two groups (P > 0.05). To conclude, both intramedullary nail and shoulder hemiarthroplasty are effective surgical procedures for proximal humeral fracture with varus deformity. Intramedullary nailing is more invasive, with better recovery of shoulder function.

Key words: proximal humeral fracture, intramedullary nailing, internal fixation, shoulder hemiarthroplasty, varus deformity

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