| Objective: Proximal Humeral Fracture(PHF)accounts for a high proportion in senile osteoporotic fractures,mainly due to indirect violence such as falling.After the injury,the patient will experience shoulder and elbow pain with impaired mobility.According to statistics,the incidence rate of elderly patients over the age of 65 is 150 per 100,000 for men and 424 per 100,000 for women,and the number of cases is expected to reach 275,000 per year by 2030.More than 80% of fractures can be treated conservatively to achieve satisfactory healing.Surgical treatment: internal fixation therapy,shoulder replacement and arthroscopic surgery.PHF can be divided into four types: non-surgical treatment is preferred for type Ⅰ fracture,joint replacement is preferred for type Ⅳ fracture due to severe comminution,and locking plate or intramedullary nail fixation is preferred for type Ⅱ and Ⅲ fracture treatment.PHILOS plate and 3rd generation intramedullary nail are the most prominent,and they have achieved good results.The principle of the PHILOS plate is to lock and Angle the fracture by locking the pressure thread between the plate and the screw,but it is eccentric fixation,which is prone to varus deformity of the humeral head.However,the biomechanical design of the third generation of intramedullary nail is intramedullary central fixation,which has strong anti-rotation ability and stronger support effect on the internal wall,so as to reduce the occurrence of varus deformity.Due to the relatively mature technology of locking plate,it is frequently used in clinical practice.But the intramedullary nail has unique mechanical advantages,and many clinicians will also prioritize it.In clinical practice,there is no unified standard on which surgical method is better.Therefore,this study is a comparative analysis of the efficacy of the two groups of treatment methods for NeerⅡ and Ⅲ proximal humerus fractures.Methods: A total of 61 PHF patients from the Second Affiliated Hospital of Dalian Medical University and Huludao Central Hospital from January 2019 to December 2021 were collected by retrospective analysis.34 patients were treated with PHILOS locking plate(control group)and 27 patients were treated with third-generation intramedullary nailing(experimental group).Data related to the two groups of operations were collected: intraoperative blood loss,operation time,hospitalization period,intraoperative fluoroscopy times,etc.The range of motion of the shoulder joint of the two groups was investigated periodically(1 week and 1,3 and 6 months after surgery),and the changes of the postoperative cervical trunk Angle and the healed cervical trunk Angle were recorded,as well as the VAS before and 1 and 1 week after surgery(visual analogue scale,Pain visual simulation score)Pain score,Constant-Murley(C-M)activity score of shoulder joint after surgery,good and good rate,and the occurrence of related complications after treatment.The shoulder joint activity and function of patients at 1,2,3 months,6 months and 1 year after surgery were evaluated and relevant data were collected.At the same time,X-ray was periodically reviewed in the outpatient department to observe the fracture end healing and internal fixation.P<0.05 was considered as statistically significant.Results: In this study,there were 27 patients in the intramedullary nailing group,including 7 males and 20 females.There were 17/10 cases of 2-part and 3-part fractures,respectively.The mean age was 73.11±11.34 years old.A total of 34 patients in the locking plate group,including 9 male patients and 25 female patients,were 26/8patients with 2-part and 3-part fractures,respectively.The mean age was 69.56±13.12 years old.There were no significant differences in gender,age distribution and fracture classification between the two groups(P>0.05).The experimental group was less than the control group in the data of operation time,intraoperative blood loss and hospitalization days,and the experimental group was significantly better than the control group in the postoperative dry neck Angle,the healed dry neck Angle and △ dry neck Angle,and there were significant statistical differences between the two groups(P< 0.05).In the number of intraoperative radioscopy,the control group(12.15±2.808times)and the experimental group(21.19±3.742 times),the control group was better than the experimental group and the difference was statistically significant(P < 0.001).One week after the operation,the experimental group was significantly higher than the control group in the functions of forward flexion,shoulder abduction,shoulder rotation and so on,with significant statistical difference(P < 0.001),but no significant difference in the function of internal rotation one week after the operation(P>0.05).One month after surgery,the experimental group was significantly better than the control group in the function of forward flexion and upward lifting,lateral shoulder display,outward rotation and inward rotation(P < 0.001).There were no significant differences in the functions of flexion,abduction,external rotation and internal rotation between the third and sixth months after surgery(P > 0.05).The C-M score of the shoulder joint in the first,second,third and sixth months after surgery was significantly higher in the intramedullary nailing group than in the locking plate group,and the difference was statistically significant(P < 0.05).There was no significant difference in the C-M function scores of the shoulder joint before surgery and 1 year after surgery,as well as the excellent and good rate of C-M and the occurrence of complications of the shoulder joint after surgery(P > 0.05).VAS scores of 1 day and 1 week after surgery were higher in the control group than in the experimental group,and the difference was statistically significant(P < 0.05).Conclusions: 1.Compared with PHILOS plate,the third-generation intramedullary nail has shorter operation time,less intraoperative blood loss,shorter hospitalization period,and less loss of cervical trunk Angle.However,the number of intraoperative fluoroscopy was significantly reduced in the plate group.2.Early postoperative observation showed that intramedullary nail was beneficial to patients’ shoulder joint functional recovery and rehabilitation exercise,as well as reducing postoperative pain.However,long-term follow-up showed no significant differences between the two treatments in functional recovery,the excellent and good rate of Constant-Murley score of shoulder joint and the probability of complications. |
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