LCP、锁钉及多针固定中老年肱骨外科颈骨折对比探究.doc

LCP、锁钉及多针固定中老年肱骨外科颈骨折对比探究 　 作者：任民，文益民，王世勇，张军华 【摘要】 目的 探讨锁定加压钢板（LCP）、带锁髓内钉和多枚克氏针应用在中老年肱骨外科颈复杂性骨折治疗中的临床疗效。方法 对本院2002年10月—2007年3月手术治疗并获得1年随访的肱骨外科颈骨折58例，年龄39～65岁，NeerⅡ型骨折33例，Ⅲ～Ⅳ型骨折25例，按手术方式不同分为：LCP组36例，带锁髓内钉治疗组(A组)11例，多枚克氏针治疗组（B组）11例，各组均采用手法复位。术后就术中出血量、切口总长度、伤口延迟愈合率、8周骨折愈合率、术后肩关节外展活动度方面，将LCP组分别与A组、B组进行统计学分析，肩关节功能按ConstantMurley绝对值标准评分。结果 LCP组和A组比较切口总长度、伤口延迟愈合率、8周骨折愈合率无统计学意义(P＞0.05)，两组术中出血量、肩关节最大外展度数有统计学意义(Plt;0.05)。LCP组和B组比较术中出血量、伤口延迟愈合率无统计学意义(P＞0.05)，两组切口总长度、8周骨折愈合率、肩关节最大外展度数有统计学意义(Plt;0.05)。肩关节功能ConstantMurley绝对值评分结果：治疗Ⅱ型骨折LCP组优良率90.9%，Ⅲ～Ⅳ型骨折LCP组优良率85.7%。A组优良率45.5%，B组优良率36.4%。结论 治疗中老年肱骨外科颈复杂性骨折首选应用锁定加压钢板技术固定，其临床疗效优于带锁髓内钉和多枚克氏针固定技术。 【关键词】 钉加压钢板；带锁髓内钉；克氏针；肱骨外科颈骨折 　　Abstract： Objective To analyze the clinical efftects of aged patients with complicated surgical neck fractures of humerus treated by locking compression plate (LCP), interlocking intramedullary nail and multiKirschner wire.Methods We retrospectively studied surgically treated 58 cases (during October 2002March 2007, in Lanzhou General Hospita1) of surgical neck fractures of humerus and trailed over 1 year, age 39-65. Among 58 cases,33 cases were typeⅡfractures and 25 cases were typeⅢⅣ fractures based on Neer classification; 36 cases were treated with locking compression plate (group LCP), 11 cases were treated with interlocking intramedullary nail (group A) and 11 cases were treated with multiKirschner wire (group B) based on different operations. After operation, group LCP statistically compared with group A or group B in regard to intraoperative bleed volume, sum of operative incision length, delayed union rate of operative incision, fracture union rate of 8 weeks and postoperative abducens range of shoulder joint motion. All groups suffered manipulative reduction. Selecting Constantmurley System as a assessment standard to evaluate shoulder joint function.Results Between group LCP and group A, there were no significant difference in regard to sum of operative incision length, delayed union rate of