肱骨大结节骨折块大小与肩关节复位时医源性外科颈骨折关系的研究

发布时间：2018-04-10 05:26

本文选题：肩关节脱位　切入点：大结节骨折　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:肩关节脱位伴肱骨大结节骨折(greater tuberosity fractures,GTF)在临床中越来越常见,同时,近年来不断有该类患者在复位过程中造成的医源性肱骨外科颈骨折(iatrogenic humeral surgical neck fractures,IHSNF)的病例报道。本文旨在研究肱骨大结节骨块大小与医源性肱骨外科颈骨折的发生之间的关系,并提出假设:肱骨大结节骨块的大小是引发肩关节脱位伴肱骨大结节骨折患者在复位过程中发生医源性骨折的相关因素。方法:回顾性研究从2013年7月至2015年7月河北医科大学第三医院创伤急救中心收治的肩关节脱位伴肱骨大结节骨折的74例患者(76例患肩),平均年龄52.4岁(18-84岁)。收集并分析所有患者的基线资料,包括年龄、受伤机制、患侧、治疗等待时间以及复位方式。将所有患者分为两组,即在复位过程中发生医源性肱骨外科颈骨折组(A组)和未发生医源性肱骨外科颈骨折组(B组)。在常规肩关节正位片中标记A,B和C三点。点A为患侧肱骨大结节顶点,点B为患侧肱骨外科颈及解剖颈之间内侧皮质上曲率最大处,线段AB与大结节骨折线交于点C。分别测量线段AB和AC长度并计算出AC/AB值。通过受试者工作特征曲线(Receiver Operating Characteristic curve,ROC)计算出最佳临界值为0.3982。将所有患者的AC/AB值与最佳临界值0.3982比较并做相应的统计学分析去探索肱骨大结节骨块大小与医源性骨折的发生是否存在关系。结果:更多的医源性肱骨外科颈骨折发生在具有AC/AB值大于0.3982的患者中。76例患肩中,共有18例发生了医源性骨折(23.7%)。其中,5例具有AC/AB值小于等于0.5,16例具有AC/AB值小于等于0.6。此外,大部分(13例)医源性肱骨外科颈骨折发生在急诊行Hippocratic手法复位时,仅5例(27.78%)发生在手术牵引复位过程中。女性相较于男性具有更大的医源性骨折发生风险(男女比例为1:8)。该类骨折的发生中,女性患者平均年龄比男性患者更大(女性患者平均59.75岁vs.男性患者平均42岁)。结论:在肩关节脱位伴肱骨大结节骨折的患者中,年龄在50岁及以上的女性以及肱骨大结节骨块的大小是复位过程中易导致医源性肱骨外科颈骨折的危险因素。在肩关节正位片中,当大结节骨块和外科颈的比值大于0.3982时,患者肩关节在复位尤其是闭合复位过程中易发生医源性肱骨外科颈骨折。通过测量肱骨大结节骨块的大小,能够在极大程度上帮助急诊和临床医生选择恰当的临床治疗方案,以预防医源性骨折,取得最佳预后。
[Abstract]:Objective: shoulder joint dislocation with greater tuberosity of humerus fractures (greater tuberosity, fractures, GTF) in clinical practice is more and more common, at the same time, in recent years there have been iatrogenic surgical neck of the humerus of the patients resulted in reduction in the process of fracture (iatrogenic humeral surgical neck fractures, IHSNF) were reported. The purpose of this paper is to study the relationship between the humerus large nodules occur between bone size and iatrogenic fracture of surgical neck of humerus, and put forward a hypothesis that the greater tuberosity of humerus bone block size is the cause of shoulder joint dislocation with greater tuberosity of humerus in patients with iatrogenic factors related to fracture in the reduction process of fracture dislocation. Methods: retrospective study from July 2013 to July 2015 the Third Hospital of Hebei Medical University trauma emergency center from shoulder joint in 74 cases with fracture of the greater tuberosity patients (76 cases of shoulder), with an average age of 52.4 years (18-84 years) and analyze the collected. Baseline data, including patients age, mechanism of injury, the affected side, waiting time for treatment and reduction. All patients were divided into two groups, namely the occurrence of iatrogenic fracture of surgical neck of humerus during reduction (A group) and no iatrogenic fracture of surgical neck of humerus group (B group). Mark A in conventional shoulder radiographs, B and C three. A in the affected side of the apex of greater tuberosity at B, patients of humeral surgical neck and lateral neck dissection between the medial cortex on the maximal curvature, line AB and line to the greater tuberosity fracture of C. were measured and the length of the AC line AB and the AC/AB value was calculated. The receiver operating characteristic curve (Receiver Operating Characteristic curve, ROC) to calculate the optimal critical value for 0.3982. of all patients with AC/AB 0.3982 and compared the corresponding analysis to explore the greater tuberosity of humerus bone block size and iatrogenic fracture and the optimal critical value The existence of relationship. Results: with AC/AB values greater than 0.3982 of patients in.76 patients with shoulder in iatrogenic fracture of surgical neck of humerus more, there were 18 cases with iatrogenic fracture (23.7%). Among them, 5 cases with AC/AB value less than or equal to 0.5,16 cases with AC/AB value less than or equal in addition 0.6., most (13 cases) occurred in the emergency Hippocratic manual reduction of iatrogenic fracture of surgical neck of humerus, only 5 cases (27.78%) occurred in the operation of traction reduction process. Women than men with iatrogenic greater fracture risk (the ratio of male to female was 1:8). The occurrence of fracture in the average age of female patients more than male patients (female patients with an average of 59.75 years old vs. male patients with an average age of 42). Conclusion: in the shoulder joint dislocation with fracture of greater tuberosity of humerus in women aged 50 and above and the greater tuberosity of humerus bone block size The risk factors of iatrogenic fracture of surgical neck of humerus is easy to cause the reset process. In the shoulder joint radiographs, when the ratio of greater tuberosity fragment and surgical neck is more than 0.3982, especially in patients with shoulder joint reduction and closed reduction is likely to occur in the process of iatrogenic fracture of surgical neck of humerus. By measuring the greater tuberosity of humerus the bone block size, clinical treatment can help clinicians in the selection of appropriate emergency and to a great extent, in order to prevent iatrogenic fracture, achieve the best prognosis.

【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

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