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中华肩肘外科电子杂志 ›› 2025, Vol. 13 ›› Issue (02) : 87 -94. doi: 10.3877/cma.j.issn.2095-5790.2025.02.004

论著

髓内钉和锁定钢板治疗肱骨近端合并肱骨干骨折的对比研究
高健1, 高雷2, 贺飞帆1, 陆杨1, 高冲3,()   
  1. 1. 830002 乌鲁木齐,新疆医科大学第六附属医院关节外科
    2. 466600 周口,西华中医骨科医院骨科
    3. 222006 连云港市第二人民医院骨科
  • 收稿日期:2025-03-17 出版日期:2025-05-05
  • 通信作者: 高冲
  • 基金资助:
    连云港市卫生科技项目(QN202416)

Intramedullary nail and locking plate osteosynthesis for proximal humerus fractures combined with humeral shaft fractures: a comparative study

Jian Gao1, Lei Gao2, Feifan He1, Yang Lu1, Chong Gao3,()   

  1. 1. Department of Joint Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002, China
    2. Department of Orthopedics, Xihua Traditional Chinese Medicine Orthopedics Hospital,Zhoukou 466600,China
    3. Department of Orthopedics, The Second People's Hospital of Lianyungang,Lianyungang 222006, China
  • Received:2025-03-17 Published:2025-05-05
  • Corresponding author: Chong Gao
引用本文:

高健, 高雷, 贺飞帆, 陆杨, 高冲. 髓内钉和锁定钢板治疗肱骨近端合并肱骨干骨折的对比研究[J/OL]. 中华肩肘外科电子杂志, 2025, 13(02): 87-94.

Jian Gao, Lei Gao, Feifan He, Yang Lu, Chong Gao. Intramedullary nail and locking plate osteosynthesis for proximal humerus fractures combined with humeral shaft fractures: a comparative study[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2025, 13(02): 87-94.

目的

通过对比研究明确髓内钉和锁定钢板治疗肱骨近端合并肱骨干骨折的疗效。

方法

依据纳入标准及排除标准,回顾性分析新疆医科大学第六附属医院2020年1月至2024年1月收治的肱骨近端骨折合并同侧肱骨干骨折患者41例的临床资料,依据不同固定方式分为髓内钉(intramedullary nailing, IMN)治疗组和锁定钢板(locking plate osteosynthesis, LPO)治疗组。评估手术时间、手术出血量、手术切口长度、骨折愈合时间、Constant-Murley 肩关节评分(Constant-Murley score, CMS)、上肢功能评定表(the disabilities of the arm, shoulder, and hand score, DASH)。

结果

LPO组平均手术时间为(92.25±16.18)min,IMN组为(96.43±22.98)min,两组间差异无统计学意义(t=0.670,P=0.507)。LPO组平均手术出血量为(176.75±91.14)ml,IMN组为(107.86±26.39)ml,IMN组明显优于LPO组(t=3.253,P=0.004)。LPO组平均手术切口长度为(17.90±4.28)cm,IMN组为(7.67±0.73)cm,IMN组明显优于LPO组(t=10.803,P=0.000)。LPO组平均骨折愈合时间为(13.85±1.79)周,IMN组为(12.67±1.24)周,IMN组明显优于LPO组(t=2.476,P=0.018)。LPO组平均CMS得分为(86.65±6.91)分,IMN组为(88.29±6.87)分,两组间差异无统计学意义(t=0.760,P=0.452)。LPO组平均DASH得分为(16.00±6.36)分,IMN组为(12.57±5.11)分,两组间差异无统计学意义(t=1.909,P=0.064)。

结论

LPO和IMN均可作为肱骨近端骨折合并同侧肱骨干骨折治疗的有效措施,但IMN在减少手术出血量、减少手术切口长度及骨折愈合时间上表现出明显优势。

Background

Although proximal humeral fractures combined with ipsilateral humeral shaft fractures are rare, in recent years, with the increase of high-energy injuries, the incidence rate has been increasing yearly and can account for 1%-2% of all humeral fractures. Due to its multiple and complex fractures, there are many difficulties in its treatment, and factors such as intraoperative reduction, selection of internal fixation, and functional rehabilitation exercises need to be considered.Traditional treatment mainly adopts conservative treatment, which has a long fixation time and is prone to complications such as nonunion of fractures and joint stiffness. Therefore, more and more patients are adopting surgical internal fixation treatment. Currently, intramedullary nails (IMN) and locking plate osteosynthesis(LPO)may be considered for the fixation of proximal humeral fractures combined with humeral shaft fractures. LPO can provide stable fixation and has strong angular stability. However, the surgery requires extensive dissection of soft tissues and disruption of the periosteal blood supply, which may lead to delayed healing or nonunion of fractures. Although IMN reduces soft tissue dissection injury and enables early weight-bearing activities, its disadvantages include rotator cuff damage and unstable rotation.

Objective

To compare the efficacy of intramedullary nails and locking plates in treating proximal humeral fractures combined with humeral shaft fractures was clarified.

Methods

Based on the inclusion and exclusion criteria, a retrospective analysis was conducted on the clinical data of 41 cases of proximal humeral fractures combined with ipsilateral brachial shaft fractures admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2024. They were divided into the intramedullary nail treatment group (IMN) and the locking plate treatment group(LPO) according to different fixation methods. The operation time, surgical bleeding, incision length,fracture healing time, Constant-murley score(CMS), and the disabilities of the arm, shoulder,and hand score(DASH) were evaluated.

Results

The average operation time of the LPO group was(92.25±16.18)min, and that of the IMN group was (96.43±22.98)min. The two groups had no statistically significant difference (t=0.670, P=0.507). The average surgical blood loss in the LPO group was (176.75±91.14)ml, and that in the IMN group was (107.86±26.39)ml. The IMN group was significantly better than the LPO group (t=3.253, P=0.004). The average incision length of the LPO group was (17.90±4.28)cm, and that of the IMN group was(7.67±0.73)cm. The IMN group was significantly better than the LPO group (t=10.803, P=0.000). The average fracture healing time in the LPO group was (13.85±1.79)weeks, and that in the IMN group was (12.67±1.24)weeks.The IMN group was significantly better than the LPO group (t=2.476, P=0.018). The average CMS score of the LPO group was (86.65±6.91)points, and that of the IMN group was(88.29±6.87)points. The two groups had no statistically significant difference (t=0.760, P=0.452).The average DASH score of the LPO group was (16.00±6.36)points, and that of the IMN group was(12.57±5.11)points. There was no statistically significant difference between the two groups (t=1.909,P=0.064).

Conclusion

Both LPO and IMN can be used as effective measures for treating proximal humeral fractures combined with ipsilateral humeral shaft fractures. However, IMN shows obvious advantages in reducing surgical bleeding, shortening surgical incision length, and fracture healing time.

表1 肱骨近端骨折合并同侧肱骨干骨折患者基本资料
治疗方式 年龄(岁) 性别 累计肱骨干部位 近端 OTA 分型 肱骨干 OTA 分型 受伤原因
LPO 32 近段 11-B3 12-A3 车祸伤
LPO 52 近段 11-B2 12-A2 坠落伤
LPO 44 近段 11-B2 12-A2 车祸伤
LPO 51 中段 11-A3 12-A2 机械损伤
LPO 36 近段 11-B3 12-B1 车祸伤
LPO 40 近段 11-B2 12-A2 车祸伤
LPO 35 近段 11-A3 12-A2 坠落伤
LPO 36 中段 11-B3 12-A2 车祸伤
LPO 40 近段 11-B3 12-A3 车祸伤
LPO 71 近段 11-B3 12-A2 车祸伤
LPO 50 中段 11-B2 12-A3 坠落伤
LPO 38 近段 11-B3 12-A2 车祸伤
LPO 35 中段 11-B3 12-A3 车祸伤
LPO 45 近段 11-A2 12-A3 坠落伤
LPO 41 中段 11-B3 12-A3 车祸伤
LPO 39 近段 11-B3 12-A3 车祸伤
LPO 36 中段 11-A3 12-A2 坠落伤
LPO 40 近段 11-B3 12-A2 车祸伤
LPO 35 近段 11-B3 12-A3 车祸伤
LPO 50 近段 11-B3 12-B1 坠落伤
IMN 38 中段 11-B3 12-A3 坠落伤
IMN 35 近段 11-A2 12-A3 车祸伤
IMN 45 近段 11-B3 12-A3 坠落伤
IMN 41 近段 11-A2 12-B1 车祸伤
IMN 39 中段 11-B3 12-A3 车祸伤
IMN 55 近段 11-B3 12-A3 车祸伤
IMN 61 近段 11-B2 12-A2 车祸伤
IMN 37 中段 11-B3 12-A2 车祸伤
IMN 56 近段 11-B2 12-A2 坠落伤
IMN 45 近段 11-B3 12-A2 车祸伤
IMN 41 中段 11-B3 12-A2 车祸伤
IMN 38 近段 11-B3 12-A3 坠落伤
IMN 39 中段 11-B3 12-A3 车祸伤
IMN 36 中段 11-B2 12-B1 车祸伤
IMN 40 近段 11-B3 12-A3 坠落伤
IMN 66 中段 11-A2 12-A3 车祸伤
IMN 52 近段 11-B3 12-A3 机械损伤
IMN 38 近段 11-B3 12-A3 车祸伤
IMN 33 近段 11-B2 12-A3 坠落伤
IMN 42 中段 11-B3 12-A3 车祸伤
IMN 63 近段 11-A3 12-A3 坠落伤
表2 肱骨近端骨折合并同侧肱骨干骨折患者基本资料对比
表3 两组患者术中情况比较(
图1 患者,女性,50岁,坠落伤,入院时行X线片(图A-B)示肱骨近段骨折累计同侧近端肱骨干骨折,择期行手术钢板内固定治疗;术后1周复查X线片(图C-D)示骨折对位对线良好,内固定位置可靠;术后16周复查X线片(图E-G)显示骨折线消失,连续骨小梁通过骨折线,内固定位置良好
图2 患者,女性,38岁,车祸伤,入院时行X线片(图A-B)及CT(图C-D)示肱骨近段骨折累计同侧近端股骨干骨折,择期行手术髓内针内固定治疗;术后2 d复查X线片(图E-F)示上肢力线良好,内固定位置可靠;术后12周复查X线片显示骨折线消失,连续骨小梁通过骨折线;术中切口愈合良好,长度约为5 cm(图I),患者上举、前屈、后伸功能恢复良好(图J-L),CMS评分为 96分,DASH 评分为6分 注:CMS为Constant-Murley肩关节评分;DASH为上肢功能评定表
表4 两组患者术后情况比较(
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