肱骨干骨折术后旋转移位及其对肩关节功能影响的研究  

The research of the postoperative malrotation of humeral shaft fracture and the correlative analysis between the deformity and the shoulder function

作　　者：刘洪波[1] 王呈[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中国医刊》2011年第8期44-47,共4页Chinese Journal of Medicine

摘　　要：目的研究肱骨干骨折术后旋转畸形的程度及其对肩关节功能的影响。方法两组肱骨干骨折病例(共45例)随机分成顺行髓内钉(IMN)及切开复位钢板内固定组(ORIF),术后CT测量肱骨头后倾角变化以评价旋转畸形程度,肩关节功能评分、骨折愈合情况及肩关节内外旋转肌力也分别被记录并分析。结果髓内钉组肩关节评分低于钢板组,髓内钉组的旋转移位程度明显大于钢板组,该组有27.2%的患者术后肱骨头后倾角变化超过20°,全部为骨折近端内旋移位畸形,而钢板组没有1例出现后倾角变化超过20°。旋转畸形与肩关节内外旋转范围显著相关,旋转畸形与肩关节内外旋肌力变化无明确关系。结论术后1年随访时IMN组的肩关节功能评分低于ORIF组,并且肩关节活动范围的丢失程度也较ORIF组大。IMN组的术后旋转畸形超过20°的病例高达27.2%,较大的旋转畸形可能导致肩关节继发退行性变。旋转畸形的程度直接影响到肩关节的内外旋活动范围。Objective To research postoperative malrotation of humeral shaft fracture and analyze the correlation between deformity and shoulder function. Methods Antegrade intramedullary natiling （ IMN ） and open reduction and internal fixation （ORIF） were respectively applied in two groups of humeral diaphysis fracture eases. Malrotation, union status, shoulder functional score and rotating strength were recorded and analyzed. Results IMN had lower functional scores and a decreased range of rotation of involved shoulder than ORIF group （ P 〈 0.05 ）. The IMN group also had greater degree of malrotation as compared to ORIF group （P 〈 O. O1 ）. The degree of malrotation cor- related with alteration of range of rotation（ P 〈 0.05 ）. Both IMN and ORIF suffered considerable rotator strength loss （ almost 50% ） ,. while no correlation between rotator strength and malrotation was detected. Conclusions The shoul- der function scores in IMN group is lower than that is in ORIF group after one year follow-up , and the loss of the shoulder movement range is more in IMN group than it is in ORIF group. The cases that rotation deformity is above 20 degree postoperatively are more up to 27.2% in IMN group. The greater rotation deformity maybe cause the see- ondary degeneration of shoulder joint. The degree of the rotation deformity can directly effect the shoulder movement range on the external and internal rotation.

关 键 词：肱骨干骨折 旋转畸形 肩关节功能 

分 类 号：R683.4[医药卫生—骨科学]