老年Neer Ⅵ型肱骨近端骨折合并肩关节后脱位的手术治疗

发布时间：2018-12-17 15:29

【摘要】：[目的]探讨钢板固定、缺损处植骨结合锚钉修补肩袖治疗肱骨近端Neer Ⅵ型骨折合并肩关节后脱位。[方法]采用扩大的肩峰下经三角肌入路,暴露后脱位肱骨头及关节囊,松解周围嵌顿软组织,持续牵引下拨肱骨头,复位肩关节,复位撕脱大小结节,克氏针临时固定,PHILOS钢板固定,肱骨头下骨折处植入同种异体骨给予支撑。置入锚钉,依次修复撕裂的肩胛下肌、冈上肌腱。[结果]本组患者平均手术时间(110±25)min,术中平均出血量(120±25)ml,平均住院时间17 d。22例患者均获得随访,随访时间1~15个月,19例骨性愈合,2例出现肱骨头缺血性坏死,1例出现骨折不愈合并断端吸收。Neer评级:优9例,良10例,可1例,差2例,优良率86.3%。[结论]对于肱骨近端骨折合并肱骨头后脱位的老年患者,采用PHILOS钢板固定、骨折缺损处植骨结合锚钉修复肩袖治疗固定牢固,骨折愈合良好,肩关节功能重建良好。
[Abstract]:[objective] to explore the treatment of proximal humeral Neer VI fracture with posterior dislocation of shoulder with plate fixation, bone graft and anchor nail repair. [methods] the humerus head and articular capsule were exposed, the surrounding embedded soft tissue was loosened, the humeral head was continuously pulled down, the shoulder joint was reduced, and the small tubercle was reduced and avulsed through deltoid muscle approach, and the Kirschner needle was temporarily fixed. PHILOS plate was used to fix the subhead fracture of the humerus and the allograft was implanted to support it. Anchors are placed to repair the torn subscapular muscles and supraspinatus tendons in turn. [results] the mean operative time was (110 卤25) min, the mean blood loss was (120 卤25) ml, the mean hospitalization time was 17 d.22 cases were followed up for 1 ~ 15 months, 19 cases had bone healing. There were 2 cases of ischemic necrosis of humerus head, 1 case of nonunion of fracture and resorption of broken end. Neer rating: excellent in 9 cases, good in 10 cases, fair in 1 case, poor in 2 cases, excellent and good rate was 86.3%. [conclusion] for the elderly patients with proximal humeral fracture combined with posterior dislocation of the humerus head, PHILOS plate fixation, bone graft at the fracture defect combined with anchor nail to repair the rotator cuff were used to treat the fixation firmly, the fracture healed well, and the shoulder joint function was reconstructed well.
【作者单位】：郑州市骨科医院;
【分类号】：R687.3

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