肱骨近端角度变化对锁定钢板治疗肱骨近端骨折的影响

发布时间：2018-04-13 14:07

本文选题：肱骨近端骨折 + 肱骨后倾角　；参考：《上海交通大学》2015年硕士论文

【摘要】：【目的】使用CT重建的方法测量锁定钢板治疗的患者肱骨近端角度的变化,并使用模型骨重建骨折畸形模型,探讨肱骨近端角度变化对骨折预后的影响原因。【方法】在第一部分实验中,将CT重建测量技术结合降噪、去除伪影等方法,首次应用于锁定钢板治疗的肱骨近端骨折患者的随访中。从2012年9月至2014年10月随访了54例锁定钢板(AO PHILOS)治疗的肱骨近端骨折患者。其中38患者完成12个月及以上随访,使用CT三维重建法测量患者双侧肱骨近端后倾角和颈干角。并记录患者视觉模拟评分(VAS)、肩关节功能Constant评分及并发症等。通过双侧肩关节比较,将患者分为肱骨后倾角增加组、后倾角减小组及颈干角增大组、颈干角减小组。在第二部分实验中,将人工骨在外科颈处截骨,使用锁定钢板(AO PHILOS)在不同后倾角度下固定,建立五组各十具肱骨后倾角畸形模型,分别为:后倾20°组、后倾20°组、正常组、前倾10°组、前倾20°组,并测量不同模型上每个钢板锁定孔对应的锁定螺钉最大长度,最后统计分析肱骨倾角的改变是否影响了锁定钢板上头螺钉的最大长度。【结果】患侧肩肱骨后倾角与健侧相比较,两者差别无统计学意义,但患侧肩肱骨颈干角显著大于健侧肩。三种骨折类型在组间分布无显著差异。在肱骨颈干角增大组与减小组之间末次随访VAS评分,并发症发生率及末次随访Constant评分差异均无统计学意义。肱骨后倾角减小组的术后并发症发生率明显较低且末次随访Constant评分显著高于肱骨后倾角增大组。肱骨后倾角前倾20°组和后倾20°组的螺钉总体长度均显著小于其他三组,其中前下方向的两颗螺钉最大长度均显著低于其他组。【结论】与健侧肩关节相比,患侧肱骨颈干角增大或减小对接受锁定钢板治疗的患者预后影响不大,但肱骨后倾角相较于健侧增大是患者预后的危险因素之一。肱骨后倾角改变达到20°时会显著缩短肱骨头前下方向的螺钉最大长度。
[Abstract]:[objective] to measure the changes of proximal humerus angle in patients treated with locking plate with CT reconstruction, and to reconstruct the fracture deformity model with model bone.To investigate the influence of proximal humerus angle change on fracture prognosis. [methods] in the first part of the experiment, CT reconstruction technique was combined with noise reduction, artifact removal, etc.It was first used in the follow-up of patients with proximal humerus fracture treated with locking plate.From September 2012 to October 2014, 54 patients with proximal humeral fractures treated with locked plate or AO PHILOS were followed up.38 patients were followed up for 12 months or more. The posterior inclination and neck shaft angle of bilateral humerus were measured by CT 3D reconstruction.Visual analogue score (VAS), shoulder function score (Constant) and complications were recorded.According to the bilateral shoulder joint comparison, the patients were divided into three groups: the humeral posterior inclination increased group, the posterior inclination decreased group and the neck trunk angle increased group, and the cervical trunk angle decreased group.In the second part of the experiment, the artificial bone was cut off at the surgical neck and fixed with locking plate (AO PHILOS) at different backward tilting angles. Ten humeral obliquity deformity models were established in each of the five groups. They were: backward tilting 20 掳group, backward 20 掳group, normal group.The maximum length of locking screws corresponding to each locking hole of steel plate was measured in 10 掳forward tilting group and 20 掳forward tilting group.Finally, statistical analysis was made on whether the change of humeral obliquity affected the maximum length of head screw on locking plate. [results] there was no significant difference between the affected shoulder and humeral posterior angle and the healthy side.But the humerus neck shaft angle of the affected side shoulder was significantly higher than that of the healthy side shoulder.There was no significant difference in the distribution of the three fracture types among groups.There was no significant difference in VAS score, complication rate and Constant score between the group with increased humeral neck shaft angle and the subtraction group.The incidence of postoperative complications in the group with reduced posterior humeral inclination was significantly lower than that in the group with increased posterior inclination of humerus. The Constant score of the last follow-up was significantly higher than that of the group with increased posterior humeral inclination.The total length of the screws in the 20 掳and 20 掳backward tilting groups was significantly smaller than that in the other three groups, and the maximum length of the two screws in the anterior and lower direction was significantly lower than that in the other groups. [conclusion] compared with the healthy shoulder joint, the maximum length of the two screws was significantly lower than that of the other two groups.The increase or decrease of the neck shaft angle of the affected humerus had little influence on the prognosis of the patients treated with locking plate, but the humeral posterior inclination angle was one of the risk factors of prognosis compared with the healthy side.The maximum length of the screw in the anterior and lower direction of the head of the humerus was significantly shortened when the humeral posterior inclination reached 20 掳.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.32

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