肱骨近端锁定钢板治疗中类尖顶距测量值的临床意义

发布时间：2018-06-24 10:34

本文选题：肱骨近端骨折 + 锁定钢板　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:肱骨近端骨折属于成人的上肢骨折中较为常见的类型之一,发生比例在肱骨骨折中占到将近一半,影响其发生的因素和骨质疏松有很大关系,在治疗方法上有多种的选择。就目前而言,肱骨近端锁定钢板系统的开展使用,给肱骨近端骨折的治疗带来了很好的效果。但由于肱骨近端的解剖特点及血供情况,亦有出现并发症的可能,其中最常见的是螺钉切出关节面。本文通过研究在肱骨近端骨折运用锁定钢板治疗过程中,测量并控制类尖顶距的数值,探讨类尖顶距对于肱骨近端骨折术后骨折复位的质量及减少术后并发症的影响。方法:选取因肱骨近端骨折接受锁定钢板治疗的124例患者,根据Neer分型法分类,经过术前评估,臂丛神经阻滞麻醉或静吸复合麻醉下,选择三角肌-胸大肌入路,手术方法切开复位,肱骨近端采取锁定钢板固定,术后均拍摄肱骨近端正、侧位X线片,测量类尖顶距数值。依据所测得的类尖顶距数值将其分成两组,第一组类尖顶距小于35mm,第二组类尖顶距大于35mm,观察骨折的复位质量,并跟踪随访每位患者的治疗效果。骨折复位效果的评价标准:复位优,在正侧位X线片上骨折均能达到解剖学复位;复位中:在正侧位X线片上骨折力线复位良好,但内侧、下侧皮质复位稍差,主要的骨折块移位小于2mm;复位差:在正侧位X线片上骨折力线的复位较差,骨折块分离明显,内侧、下侧的骨皮质缺损比较多。结果:肱骨近端骨折术后的跟踪随访时间10个月~18个月,平均为14个月,直到随访患者的骨折完全愈合或者X线片上表明内固定未成功。本组病例中类尖顶距小于35mm(第一组)65例,类尖顶距大于35mm(第二组)59例。组一中骨折复位优者39例,其中发生肱骨头内翻的2例(5.1%),无螺钉切出者;骨折复位中者18例,其中发生肱骨头内翻的5例(27.8%),无螺钉切除者;骨折复位差者8例,其中发生肱骨头内翻的4例(50%),螺钉切出1例(12.5%)。组二中骨折复位优者30例,其中发生肱骨头内翻的4例(13.3%),无螺钉切出者;骨折复位中者17例,其中发生肱骨头内翻的7例(41.2%),螺钉切出2例(11.8%);骨折复位差者12例,其中肱骨头内翻的6例(50.0%),螺钉切出的4例(33.3%)。组二的肱骨头内翻及螺钉切出的术后并发症发生率显著高于组一,具有统计学意义(X2=8.45,P0.01)。每组内比较,随着骨折复位质量的下降,肱骨头内翻及螺钉切出的并发症的发生率随之增高,统计学检查有显著差异,P0.05。结论:本课题通过对锁定钢板治疗肱骨近端骨折的研究,及类尖顶距的测量,得出以下结论:1类尖顶距可以快速有效的判断螺钉切出肱骨头的可能性,类尖顶距值大于35mm,术后螺钉切出肱骨头的发生率会明显增高。2骨折的复位质量如何,直接关系到运用锁定钢板治疗肱骨近端骨折的治疗效果。3在运用锁定钢板治疗肱骨近端骨折的过程中,熟悉掌握类尖顶距的解剖学特点,手术中在C型臂的透视下准确掌握内固定螺钉的位置,从而提高骨折断端的复位质量,可显著降低多种术后并发症的发生率。
[Abstract]:Objective: the proximal humerus fracture is one of the most common types of upper limb fractures in adults, which accounts for nearly half of the fracture of the humerus. The factors affecting the occurrence of the fracture are closely related to the osteoporosis, and there are a variety of options in the treatment. The treatment of end fracture has a good effect. But because of the anatomical characteristics of the proximal humerus and the condition of blood supply, there is also a possibility of complications. The most common one is to cut the articular surface of the screw. In this paper, the value of the spires was measured and controlled in the treatment process of the proximal humerus fracture with locking plate. Methods: 124 patients with proximal humerus fracture treated with locking plate were selected for the treatment of proximal humerus fractures. According to the classification of the Neer classification, the surgical method was selected by the preoperation assessment, the brachial plexus block anesthesia or the static inhalation combined anesthesia. The proximal humerus was fixed with locking plate, and the proximal humerus was photographed near the proximal end of the humerus, and the lateral X ray was taken to measure the number of the spires. The first group was less than 35mm and the second groups of spires were greater than 35mm, and the quality of the fracture reduction was observed and followed up for each patient. Therapeutic effect. Evaluation criteria of fracture reduction effect: excellent reduction and anatomical reduction on normal lateral X-ray films; reduction of fracture force line in positive lateral X ray is good, but medial, inferior lateral cortex is slightly inferior, main fracture block is less than 2mm; reduction is poor: the reduction of fracture force line on lateral X-ray film is poor. Results: the follow-up time after the proximal humeral fracture was 10 months ~18 months, averaging 14 months, until the fracture was completely healed or the X-ray showed that the internal fixation was not successful. In this group, the spires were less than 35mm (group 1), 65 cases, the spires like spires. More than 35mm (group second) 59 cases, 39 cases of one middle fracture reduction, 2 cases of humeral head internal varus (5.1%), no screw cut, 18 cases of fracture reduction, 5 cases of humeral head varus (27.8%), no screw excision, 8 fracture reduction, 4 cases (50%) of humeral head varus, 1 cases (12.5%) with screw cut. Group two. There were 30 cases of fracture reduction, including 4 cases (13.3%) of humeral head internal varus, 17 cases of fracture reduction, 7 cases of humeral head internal varus (41.2%), 2 screw cut (11.8%), 6 cases (50%) of humeral head internal varus, 4 cases (33.3%), humeral head varus and screws. The incidence of postoperative complications was significantly higher than that in the group one, with statistical significance (X2=8.45, P0.01). With the reduction of fracture reduction, the incidence of complications of humeral head varus and screws increased with the decrease of fracture reduction, and there was a significant difference in statistical examination, P0.05. conclusion: this subject was treated by locking plate for the treatment of proximal humerus. It is concluded that the 1 kind of spires can quickly and effectively determine the possibility of the screw cut out of the humeral head, and the value of the spires is greater than 35mm. The incidence of the humeral head after the operation can obviously increase the quality of the reduction of the.2 fracture, which is directly related to the treatment of the proximal humerus bone with locking plate. During the treatment of proximal humerus fracture with locking plate,.3 is familiar with the anatomical characteristics of the spires and the position of internal fixation screws under the perspective of the C arm in the operation, thus improving the quality of the broken end of the fracture, and significantly reducing the incidence of postoperative complications.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】