| 胡力.两种内固定方法治疗合并2型糖尿病的肱骨近端骨折的疗效比较[J].实用中西医结合临床,2026,26(7): |
| 两种内固定方法治疗合并2型糖尿病的肱骨近端骨折的疗效比较 |
| Comparison of the Efficacy of PHILOS Plate and Intramedullary Nailing in the Treatment of Proximal Humeral Fractures Complicated with Type 2 Diabetes Mellitus |
| 投稿时间：2025-07-24 修订日期：2025-08-18 |
| DOI： |
| 中文关键词: 肱骨近端骨折，2型糖尿病，髓内钉，PHILOS钢板 |
| 英文关键词: Proximal humeral fracture, type 2 diabetes mellitus, intramedullary nail, PHILOS plate |
| 基金项目: |
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| 中文摘要: |
| 目的：比较肱骨带锁髓内钉与PHILOS钢板内固定治疗合并2型糖尿病的肱骨近端骨折的疗效。方法：采用回顾性研究，对68例于2020年05月至2024年10月期间在福州市长乐区人民医院接受手术治疗的合并2型糖尿病的肱骨近端骨折患者进行分析。其中32例采用肱骨带锁髓内钉固定（髓内钉组）；36例接受PHILOS钢板进行内固定治疗（钢板组）。记录两组患者术中透视次数、手术时间、切口长度、术中出血量及住院时间并进行比较，同时比较两组术后6个月的肩关节疼痛（VAS评分）、功能（Constant-Murley评分）及活动度，以及术后6个月感染发生率。结果：与钢板组相比，髓内钉组手术不仅时间更短、术中透视次数少、切口长度小，且住院天数更少（均P<0.05）；但术中出血量更多（P<0.05）。术后6个月，髓内钉组患者的肩关节疼痛视觉模拟评分（VAS）显著低于钢板组，而体侧内旋角度及Constant-Murley评分则明显大于钢板组（均P<0.05）；而两组前屈上举及体侧外旋角度无明显差异（均P?0.05）。两组术后6个月的感染例数均为0。结论：处理合并2型糖尿病的肱骨近端骨折，髓内钉在减少住院时间、改善功能评分方面更具优势，而钢板组需进一步改进技术以降低围手术期创伤。对老年患者和需快速康复者，优先选择髓内钉固定。 |
| 英文摘要: |
| Objective：This study compared the efficacy of locked humeral intramedullary nailing versus PHILOS plate internal fixation in the treatment of proximal humeral fractures (PHF) complicated with type 2 diabetes mellitus (T2DM). Methods：A retrospective analysis was conducted on 68 patients with PHF complicated with T2DM who underwent surgical treatment at Changle District People"s Hospital, Fuzhou, from May 2020 to October 2024. Among them, 32 patients were treated with locked humeral intramedullary nailing (intramedullary nail group), and 36 patients were treated with PHILOS plate internal fixation (plate group). The surgical time, intraoperative fluoroscopy frequency, incision length, hospital stay, and intraoperative blood loss were compared between the two groups. Additionally, shoulder joint pain (VAS score), function (Constant-Murley score), range of motion, and the incidence of postoperative infection at postoperative 6 months were evaluated. Results：Compared with the plate group, the intramedullary nail group exhibited shorter surgical time, fewer intraoperative fluoroscopy sessions, smaller incision length, and shorter hospital stay (all P < 0.05); however, the intramedullary nail group had greater intraoperative blood loss (P < 0.05). At 6 months postoperatively, the intramedullary nail group showed lower VAS scores for shoulder pain, greater internal rotation angle at the side, and higher Constant-Murley scores than the plate group (all P < 0.05). No significant differences were observed in forward flexion, abduction, or external rotation angles between the two groups (all P > 0.05). No postoperative infections were reported in either group at 6 months. Conclusion：For proximal humeral fractures complicated with T2DM, intramedullary nailing offers advantages in reducing hospital stay and improving functional scores, while the plate group requires further technical improvements to minimize perioperative trauma. For elderly patients and those requiring rapid rehabilitation, intramedullary nailing should be prioritized. |
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