肱骨近端骨折锁定接骨板治疗术后并发症分析  

Complication analysis of proximal humeral fractures treated with locking plate

作　　者：付中国[1] 邓磊[1] 白露[1] 陈建海[1] 张培训[1] 党育[1] 张殿英[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,北京100044

出　　处：《北京大学学报（医学版）》2011年第5期666-670,共5页Journal of Peking University:Health Sciences

基　　金：“十一五”国家科技支撑计划重点项目(2007BAI04B06)资助~~

摘　　要：目的:对采用锁定接骨板治疗的肱骨近端骨折术后并发症进行分析。方法:2007年1月至2010年1月,采用锁定接骨板治疗,且随访资料完整的的肱骨近端骨折病例共计83例,其中男性30例,女性53例,平均年龄66.4岁(33～89岁)。术后平均随访23.5个月(10～51个月),采用视觉疼痛评分(visual analogue scale,VAS)、Constant-Murley评分以及肩关节前屈、外展、内旋活动度评价术后肩关节功能。采用独立样本t检验比较并发症组与非并发症组术后肩关节功能评分及活动度。采用χ2检验分析不同年龄组、不同骨折类型及是否有内科合并症组间的内固定相关及非内固定相关并发症的发生率之间的差异。结果:在全部83例患者中,共15例患者出现并发症,3例合并两种并发症,并发症发生率18.1%,其中浅表感染1例、延迟愈合1例、术后大结节移位2例、接骨板撞击肩峰3例、螺钉穿出3例、肱骨头坏死3例、肱骨头内翻畸形愈合6例,有4例合并两种或以上并发症。四部分骨折发生内固定相关并发症(P=0.009)及非内固定相关并发症(P=0.003)的几率均远高于较为简单的骨折类型。相比较而言,年龄和内科合并症对患者并发症的发生率无显著影响。结论:采用锁定接骨板治疗肱骨近端骨折虽疗效较为肯定但仍存在一定的并发症发生率。骨折的严重程度及患者的年龄是影响并发症发生的相关因素。合理的术前评估与计划、规范的手术操作,是避免并发症发生的有效途径。Objective：To analyze complications of surgically treated proximal humeral fractures with locking plate.Methods： Eighty three（30 males and 53 females） coherent unstable proximal humeral fractures were treated with locking plate from January 2007 to January 2010 with a mean follow-up lasting 23.5 months（10-51 months）.Their mean age was 66.4 years（33-89 years）.The patients were evaluated with outpatient physical examination,X-ray film,visual analogue scale（VAS）,and Constant-Murley scores.Complications and functional outcome of the involved shoulders were recorded and estimated.Complications were diagnosed in 15 cases,varus malunion in 6,humeral head necrosis in 3,delayed union in 1,screw cut-out in 3,and subacromio-impingement in 3.Four cases were combined with two or more complications.Result： Four-part fractures had higher complication risks in implant related complications（P=0.009）and none implant related complications（P=0.003）.Age and comobities had little influence on complication occurrence.Conclusion： Although locking plate provides optimal clinical results in proximal humeral fracture management,its complications should be highly considered.Preoperative evaluation,implant option,accurate reconstructions and rehabilitations are key points to restore the shoulder function.

关 键 词：肱骨骨折 骨板 骨折固定术 内 手术后并发症 

分 类 号：R683.41[医药卫生—骨科学]