| Objective: To explore the clinical effect of intramedullary nail and locking plate in the treatment of proximal humeral fractures under the guidance of the theory of "equal emphasis on muscles and bones".Methods:A total of 51 patients with proximal humeral fractures were followed up from October 2017 to April 2020 in the Department of Orthopaedics,affiliated Hospital of Shandong University of traditional Chinese Medicine,including 14 males and 37 females,with an average age of 28-88 years(62.49±14.63).According to the method of random number table,they were divided into two groups: steel plate group and intramedullary nail group.There were28 cases in the steel plate group,including 9 males and 19 females,with an average age of 28-80 years(59.00 ±14.64),and 23 patients in the intramedullary nail group,including 5 males and 18 females,aged 39-88 years(66.74 ±13.75).The operative time,incision length,fracture healing time,neck shaft angle missing value,visual analogue score on the 2nd day,7th day and 1 month after operation,range of motion of shoulder joint(flexion,abduction,rotation,extension)and postoperative complications were recorded 1 week and 1 month after operation.Constant-Murley scores were evaluated at 1,3,6 and 9 months after operation.Results: Through the analysis of the results of this study,it was found that in terms of operation,the operation time and knife edge length of the intramedullary nail group were better than those of the steel plate group,and there was statistical significance(P < 0.05).The fracture healing time and the reduction of cervical shaft angle in the intramedullary nail group were better than those in the steel plate group(P < 0.05).According to the analysis of postoperative VAS score,early postoperative shoulder range of motion,postoperative Constant-Murley shoulder function score and complications,the VAS score of intramedullary nail group was better than that of steel plate group at 1 day and 7 days after operation,but there was no significant difference between the two groups at 1 day and 7 days after operation.In the early postoperative shoulder motion,the intramedullary nail group was better than the steel plate group as a whole.One week after operation,there was significant difference in flexion,abduction and external rotation between the two groups(P < 0.05).One month after operation,there was statistical significance in flexion,abduction,external rotation and internal rotation(P < 0.05).In terms of Constant-Murley shoulder function score,the intramedullary nail group was better than the steel plate group at 1,3 and 6 months after operation,but there was no significant difference in the excellent and good rate 9 months after operation and the last follow-up.In terms of complications,the postoperative performance of the two groups was about the same,with 13.6% in the intramedullary nail group(3 times of pain around the shoulder).2 person-times of acromion impact),21.4% of the plate group(3 person-times of pain around the shoulder joint;1 person-time of acromion impact;2 person-time of delayed healing;1person-time of screw removal).There were no complications such as nonunion of fracture,necrosis of humeral head,fracture of internal fixation and so on.Conclusion:1.Under the guidance of the theory of "equal emphasis on muscles and bones" in traditional Chinese medicine,compared with locking plate,intramedullary nail has shorter operation time and less trauma during operation,which can better protect the soft tissue around shoulder and lighten the pain of shoulder joint after operation.it is beneficial to the early functional exercise of shoulder joint,contributes to the early rehabilitation of shoulder joint function,and is more in line with the theory of "attaching equal importance to muscles and bones".2.From the aspect of long-term clinical treatment,the therapeutic effect of intramedullary nail and locking plate in the treatment of proximal humeral fracture is similar,and good functional recovery can be achieved.Therefore,both of them can be used clinically for the treatment of proximal humeral fractures. |
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