交锁髓内钉治疗骨质疏松性肱骨近端并同侧肱骨干骨折的临床研究  

Intramedullary interlocking nail for treatment of osteoporotic proximal humerus and ipsilateral shaft fractures

作　　者：涂意辉[1] 张长青[2] 薛华明[1] 蔡珉巍[1] 杨安礼[1] 

机构地区：[1]上海市杨浦区中心医院骨科,200090 [2]上海市第六人民医院骨科

出　　处：《中国骨质疏松杂志》2010年第5期338-340,共3页Chinese Journal of Osteoporosis

摘　　要：目的探讨应用交锁髓内钉治疗肱骨近端合并同侧肱骨干骨折的疗效。方法2008年2月至2009年1月采用肱骨髓内钉治疗肱骨近端合并同侧肱骨干骨折患者13例,男5例,女8例;年龄为65～78岁,平均年龄68.6岁;按照AO分类肱骨近端骨折均为A1型(关节外骨折,两部分,外科颈型),肱骨干骨折分为A1型3例,A2型4例,A3型2例,B2型3例,B3型1例。结果8例患者成功行闭合复位固定术,术中出血<50ml,手术时间平均85.0min(60～125min)。其余5例行有限切开复位内固定术,术中出血量平均157.3ml(100～250ml),手术时间平均105.0min(95～150min)。所有患者平均随访12.1月(9～18月)。12例骨折愈合,平均骨愈合时间3.5月(3～5月),1例患者为多发性骨髓瘤致肱骨多发性病理性骨折,骨折未愈合。末次随访VAS评分平均为30.8分(18～70分),肩关节功能OSS评分平均为20.7分(16～31分),肘关节功能HSS评分平均为91.5分(68～95分),优良率92.3%。结论肱骨髓内钉是治疗肱骨近端合并同侧肱骨干骨折一种可供选择的有效内固定方法。Objective To discuss the effects of intramedullary nailing for treatment of osteoporotie proximal humerus and ipsilateral shaft fractures. Methods Between February 2008 and January 2009, 13 consecutive patients with proximal humerus and ipsilateral shaft fractures were treated with intramedullary nailing system, including 5 males and 8 females. The average was 68.6 years （ range, 65 - 78 years）. According to AO system,all proximal humerus fractures were classified as type A1 （extraartieular fracture, two-part,surgical neck） and the humerus shaft fractures were classified as type A1 in 3, A2 in 4, A3 in 2, B2 in 3,and B3 in 1. Results Closed reduction was successful in 8 of the 13 fractures with mean blood loss of less than 50 ml and mean operating time of 85.0 min （range,60 - 125 min） , whereas limited open reduction was required in 5 with mean blood loss of 157.3 ml （range, 100 - 250 ml） and mean operating time of 105.0 rain （range,95 - 150 min）. All cases were followed up for 12. 1 months （ range,9 - 18 months）. Bony union was obtained in 12 of 13 with a mean period of 3.5 months （range,3 - 5 months）. One patient who developed nonunion had a multiply pathological fracture caused by multiple myeloma. For the final outcome assessment,the mean VAS,OSS and HSS were 30. 8 （range,18 -70） , 20.7 （range,16 31）and 91.5 （range,68 -95） with an excellent and good rate of 92. 3%, respectively. Conclusion Intramedullary nailing system was an effective alternative for the treatment of proximal humerus and ipsilateral shaft fractures.

关 键 词：交锁髓内钉 肱骨近端骨折 肱骨干骨折 同侧 

分 类 号：R683.4[医药卫生—骨科学]