摘要
目的:对比多向锁定股骨带锁(Multiloc)髓内钉与肱骨近端锁定内固定系统(PHILOS)术治疗肱骨近端骨折的临床效果。方法:选取我院2019年1月~2021年1月收治的87例肱骨近端骨折患者为研究对象,按非随机同期对照试验方法分为Multiloc组(n=35)和PHILOS组(n=52)。Multiloc组患者行Multiloc髓内钉内固定术,PHILOS组患者行PHILOS术。比较两组患者围术期指标(手术时间、术中出血量、切口长度、术后引流量),对比两组患者术后7d凝血指标[凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)]、创伤指标[肌酸激酶(CK)、乳酸脱氢酶(LDH)、血小板计数(PLT)]水平,记录两组患者术后6个月骨吸收与代谢指标[吡啶啉(PYD)、骨形态发生蛋白-2(BMP-2)、人Ⅰ型胶原C端肽(CTX-Ⅰ)]、上肢活动能力[美国肩肘外科协会评分(ASES)],统计两组患者术后6个月内并发症发生情况。结果:Multiloc组患者手术时间、术中出血量、术后引流量显著低于PHILOS组,两组患者切口长度比较无统计学差异。术后7d,Multiloc组患者凝血指标(PT、APTT、FIB)、创伤指标(CK、LDH、PLT)水平显著低于PHILOS组。术后6个月,两组患者骨吸收与代谢指标(PYD、BMP-2、CTX-Ⅰ)、上肢活动能力(ASES)水平比较无统计学差异。术后6个月内,两组患者并发症发生情况比较无统计学差异。结论:Multiloc髓内钉与PHILOS术在肱骨近端骨折的治疗中安全性均较好,术后上肢功能恢复方面无明显差异,但Multiloc髓内钉具有手术创伤小、操作易行的优势,值得临床推广。
Objective To compare the clinical effects of multi-interlocking femoral intramedullary nail (Multiloc) and proximal humerus internal locking system (PHILOS) in the treatment of proximal humeral fractures.Methods 87 patients with proximal humeral fractures treated in the hospital between January 2019 and January 2021 were selected as the research subjects,and they were divided into Multiloc group (n=35) and PHILOS group (n=52) according to the non-randomized concurrent controlled trial.The patients in the Multiloc group underwent Multiloc intramedullary nail fixation,while the patients in the PHILOS group received PHILOS.The perioperative indicators (surgical time,intraoperative blood loss,incision length,postoperative drainage volume) and coagulation indicators [prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB)]and trauma indicators [creatine kinase (CK),lactate dehydrogenase (LDH),platelet count (PLT)]at 7 d after surgery were compared between the two groups of patients.The bone absorption and metabolism indicators [pyridinline (PYD),bone morphogenetic protein-2(BMP-2),C-terminal telopeptide of type I collagen (CTX-I)]and upper limb mobility [American Shoulder and Elbow Surgeons (ASES)]in the two groups were recorded at 6 months after surgery.The occurrence of complications within 6 months after after surgery were statistically analyzed.Results The surgical time,intraoperative blood loss and postoperative drainage volume in Multiloc group were significantly shorter or less than those in PHILOS group,and there was no statistical difference in incision length between the two groups.At 7 d after surgery,the levels of coagulation indicators (PT,APTT,FIB) and trauma indicators (CK,LDH,PLT) were significantly lower in Multiloc group than those in PHILOS group.At 6 months after surgery,there were no significant differences in bone absorption and metabolism indicators (PYD,BMP-2,CTX-I) and upper limb mobility (ASES) between the two groups.Within 6 months after surgery,the differences in the occurrence of complications were not statistically significant between the two groups.Conclusion Multiloc intramedullary nail and PHILOS are both safe in the treatment of proximal humeral fractures,and there is no significant difference in postoperative upper limb function recovery.However,Multiloc intramedullary nail has the advantages of small surgical trauma and easy operation,which is worthy of clinical promotion.
作者
张林
汤瑨
钱冬晨
徐子卿
Zhang Lin;Tang Jin;Qian Dong-chen;Xu Zi-qing(Department of orthopedics and traumatology,Jiangsu Second Hospital of traditional Chinese Medicine,Nanjing 210017,China)
出处
《晓庄学院学报（医学版）》
2022年第4期24-28,共5页
Journal of Hunan Normal University(Medical Sciences)
