肱骨近端骨折合并肩袖损伤临床特点及漏诊分析  

Analysis on Clinical Characteristics and Missed Diagnosis of the Proximal Humeral Fractures combined with Rotator Cuff Injury

作　　者：刘文源[1,2] 王义生[1] 

机构地区：[1]郑州大学第一附属医院骨科,郑州450052 [2]河南省辉县市中医院骨科

出　　处：《中国中医骨伤科杂志》2010年第5期37-38,40,共3页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的：探讨肱骨近端骨折合并肩袖损伤的临床特点及漏诊原因分析。方法：对2002年2月~2008年12月45例肱骨近端骨折合并肩袖损伤采取开放性手术治疗进行回顾性分析,术前行X线、超声检查5例,MRI检查19例,MRA检查21例,术中AO肱骨近端锁定钢板（Locking proxi mal humerus plate LPHP）固定者31例,人工肱骨头假体置换者14例。探讨此类损伤的临床特点及漏诊的防范。结果：随访8~32个月,按美国肩肘外科协会评分ASES行肩关节功能评测,LPHP组：优11例,良14例,可4例,差2例,优良率为80.6%;假体置换组：优5例,良7例,可1例,差1例,优良率为85.7%。结论：通过术前影像资料的评估,提高对NeerⅢ、Ⅳ型骨折可能合并肩袖损伤的警惕性,可减少漏诊的发生。选择合适内置物,术中精确定位及肩袖修复,可使此类损伤致残率大大下降。Objective：To investigate the clinical characteristics and causes of missed diagnosis for proximal humeral fractures combined with rotator cuff injury.Methods：From February 2002 to December 2008,45 patients of proximal humeral fractures combined with rotator cuff injury who had received open surgery were reviewed.Preoperative X-ray examinations were performed on all patients,and ultrasound examination in 5 cases,MRI in 19 cases,and MRA in 21 cases.Thirty-one cases received intraoperative fixation with AO locking proximal humerus plate（LPHP）,and 14 had humeral head prosthesis replacement.Results：All the patients were followed up for 8 to 32 months.According to the United States Association of shoulder and elbow surgery shoulder joint function score ASES-line evaluation,in LPHP group,the effect was excellent in 11 cases,good in 14,fair in 4 and poor in 2,with the good and excellent rate 80.6%;in prosthesis replacement group,the effect was excellent in 5 cases,good in 7,fair in 1 and poor in 1,with the good and excellent rate 85.7%.Conclusion：The incidence of missed diagnosis can be reduced through sufficient operative evaluation based on imaging materials and high vigilance of Neer Ⅲ and Ⅳ fracture combined with rotator cuff injury.Proper choice of implants and precise positioning and repairing of rotator cuff can significantly decrease morbidity in such cases.

关 键 词：肱骨骨折 肩袖损伤 手术 诊断 

分 类 号：R683.41[医药卫生—骨科学]