锁定钢板治疗非骨质疏松性复杂肱骨近端骨折的中期临床及影像学随访研究

发布时间：2018-10-14 20:53

【摘要】：目的:回顾性分析采用锁定钢板治疗非骨质疏松性三部分和四部分肱骨近端骨折的临床效果。方法:回顾性评估锁定钢板治疗非骨质疏松性三部分和四部分肱骨近端骨折的临床效果,统计患肢的肩关节活动度、临床评分、视觉模拟评分(visual analogue scale,VAS)和影像学检查的结果。结果:自2007年1月至2014年10月,采用锁定钢板共治疗107例新鲜非骨质疏松性三部分和四部分肱骨近端骨折,其中67例患者完成至少2年的随访,平均随访时间(43.9±23.3)个月(24~108个月)。在最终随访时,Constant评分平均为(87.1±11.7)分(51~100分),加州大学肩关节评分(the University of California at Los Angeles shoulder score,UCLA)平均为(30.5±3.9)分(18~35分),VAS疼痛评分为(1±2)分(0~7分);主动前屈上举为159.0°±19.3°(80°~180°),体侧外旋为36.8°±19.5°(0°~80°),体侧内旋为T11水平(T2~LS水平)。术后11例患者出现并发症,包括5例螺钉穿出(7.5%),9例肱骨头缺血坏死(13.4%)及5例创伤性骨性关节炎(7.5%),6例合并两种或两种以上并发症。三部分骨折和四部分骨折术后患者的肩关节活动度、临床评分和VAS疼痛评分差异无统计学意义。四部分骨折的术后并发症率及术后肱骨头缺血坏死概率显著高于三部分骨折。结论:应用肱骨近端锁定钢板治疗非骨质疏松性三、四部分复杂肱骨近端骨折可得到满意的术后肩关节功能恢复,严格的适应证选择与精细的手术操作是取得手术成功的关键,骨折的复杂程度亦对术后结果产生影响,四部分骨折的并发症发生率以及术后肱骨头缺血坏死率高于三部分骨折。
[Abstract]:Objective: to retrospectively analyze the clinical effect of locking plate in the treatment of non-osteoporosis fracture of proximal humerus. Methods: the clinical effects of locking plate in the treatment of nonosteoporotic proximal humerus fractures were retrospectively evaluated. The shoulder motion, clinical score, visual analogue score (visual analogue scale,VAS) and imaging findings of the affected limbs were analyzed. Results: from January 2007 to October 2014, 107 cases of fresh nonosteoporotic proximal humerus fractures were treated with locking plate. 67 of them were followed up for at least 2 years, with an average follow-up time of (43.9 卤23.3) months (24 ~ 108 months). At final follow-up, the average Constant score was (87.1 卤11.7) (51-100), the UCLA shoulder score (the University of California at Los Angeles shoulder score,UCLA) averaged (30.5 卤3.9) (18-35), the), VAS pain score was (1 卤2) (0-7), the active flexion was 159.0 掳卤19.3 掳(80 掳~ 180 掳), the lateral extroversion was 36.8 掳卤19.5 掳(0 掳~ 80 掳), and the intra-lateral rotation was 36.8 掳卤19.5 掳(0 掳~ 80 掳). The rotation is T11 (T2~LS level). Postoperative complications occurred in 11 patients, including 5 cases of screw perforation (7.5%), 9 cases of ischemic necrosis of the head of humerus (13.4%) and 5 cases of traumatic osteoarthritis (7.5%), and 6 cases were complicated with two or more kinds of complications. There was no significant difference in shoulder motion, clinical score and VAS pain score between patients with three and four parts fracture. The rate of postoperative complications and the probability of ischemic necrosis of humerus head were significantly higher in four-part fractures than in three-part fractures. Conclusion: using locking plate of proximal humerus to treat nonosteoporotic fracture of proximal humerus can obtain satisfactory recovery of shoulder joint function after operation. Strict indication selection and fine operation are the key to successful operation. The complication rate of four parts fracture and the rate of ischemic necrosis of humeral head were higher than that of three parts fracture.
【作者单位】：北京积水潭医院运动损伤科;
【分类号】：R687.3

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