Gracitelli Mauro E C, Malavolta Eduardo A, Assunção Jorge H, Kojima Kodi E, dos Reis Paulo R, Silva Jorge S, Ferreira Neto Arnaldo A, Hernandez Arnaldo J
Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil.
Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil.
J Shoulder Elbow Surg. 2016 May;25(5):695-703. doi: 10.1016/j.jse.2016.02.003.
Previous studies have shown good clinical results in patients with proximal humeral fractures (PHFs) treated with locking intramedullary nails or locking plates. Our study compared the clinical and radiographic outcomes in patients with 2- and 3-part surgical neck fractures.
In this prospective, randomized controlled trial, 72 patients with 2- or 3-part surgical neck PHFs were randomly assigned to receive fixation with locking intramedullary nails (nail group) or locking plates (plate group). The primary outcome was the 12-month Constant-Murley score. The secondary outcomes included the Disabilities of the Arm, Shoulder and Hand score, the visual analog scale pain score, the shoulder passive range of motion, the neck-shaft angle, and complication rates.
There was no significant mean treatment group difference in the Constant-Murley score at 12 months (70.3 points for the nail group vs. 71.5 points for the plate group; P = .750) or at individual follow-up assessments. There were no differences in the 3-, 6- and 12-month Disabilities of the Arm, Shoulder and Hand scores, visual analog scale scores, and range of motion, except for the medial rotation at 6 months. The neck-shaft angle was equivalent between the groups at 12 months. There were significant differences over 12 months in total complication rates (P = .002) and reoperation rates (P = .041). There were no significant differences for the rotator cuff tear rate (P = .672).
Fixation of PHFs with locking plates or locking intramedullary nails produces similar clinical and radiologic results. Nevertheless, the complication and reoperation rates were higher in the nail group.
既往研究表明，采用锁定髓内钉或锁定钢板治疗肱骨近端骨折（PHF）患者可取得良好的临床效果。我们的研究比较了两部分和三部分手术颈骨折患者的临床和影像学结果。
在这项前瞻性随机对照试验中，72例两部分或三部分手术颈PHF患者被随机分配接受锁定髓内钉固定（髓内钉组）或锁定钢板固定（钢板组）。主要结局指标是12个月时的Constant-Murley评分。次要结局指标包括手臂、肩部和手部功能障碍评分、视觉模拟量表疼痛评分、肩部被动活动范围、颈干角和并发症发生率。
在12个月时（髓内钉组为70.3分，钢板组为71.5分；P = 0.750）或在各个随访评估中，治疗组之间的Constant-Murley评分均值无显著差异。除6个月时的内旋外，在3个月、6个月和12个月时的手臂、肩部和手部功能障碍评分、视觉模拟量表评分及活动范围方面均无差异。两组在12个月时的颈干角相当。在12个月期间，总并发症发生率（P = 0.002）和再次手术率（P = 0.041）存在显著差异。肩袖撕裂率无显著差异（P = 0.672）。
采用锁定钢板或锁定髓内钉固定PHF可产生相似的临床和影像学结果。然而，髓内钉组的并发症和再次手术率更高。
