累及干骺端及肱骨干的肱骨近端骨折的手术治疗  

Surgical treatment of proximal humeral fracture involving metaphysis and humeral shaft

作　　者：付中国[1] 徐春归[1] 芦浩[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）》2012年第6期887-890,共4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);北京市科技支撑;市政府重点工作项目(Z101107052210001)资助~~

摘　　要：目的:对累及干骺端及骨折线延及肱骨干的骨折采用加长锁定钢板固定并分析其临床疗效。方法:2008年5月至2011年4月,采用锁定接骨板治疗,且随访资料完整的肱骨近端骨折病例共计9例,男性患者6例,女性3例,平均年龄(48.9±11.5)岁,术后平均随访21.3个月(12～46个月)。采用视觉疼痛评分(visual analogue scale,VAS),Constant-Murley评分及肩关节前屈、外展、内旋活动度评价术后肩关节功能。结果:所有患者骨折均愈合,无不愈合、延迟愈合病例。并发症:肱骨头内翻畸形愈合2例,伤口浅表感染1例,术后桡神经麻痹1例,余5例无并发症。末次随访功能情况:平均VAS评分0.22分(0～1分),Constant-Murley评分(79.7±6.5)分(71～91分);平均肩关节前屈118°±20°(90°～160°),外展95°±14°(75°～120°),内旋L1。结论:骨折线累及肱骨上段干骺端及肱骨干的肱骨近端骨折因内侧皮质损伤,骨折线为纵行且累及骨干,治疗难度较大,良好的入路选择、仔细的术中操作是术后功能良好的保证。Objective:To surgically treat proximal humeral fracture involving metaphysis and humeral shaft with long locking plate osteosynthesis.Methods:In the study,9 proximal humeral fracture cases [6 male patients and 3 female,with an average age of(48.9±11.5) years and the average post-operation follow-up duration of 21.3 months from 12-46 months] treated with locking plate and with complete follow-up observation from May 2008 to April 2011 were recruited.Visual Analogue Score(VAS),Constant-Murley Score and shoulder range of motion(forward elvation,abduction,internal rotation) were used to evaluate post-operation shoulder joint function.Results:All the cases got union of their fractures,without nonunion or delayed union.The complications were 2 cases with humeral head varus deformity,1 with wound superficial infection and 1 with post-operation radius nerve paralysis.The last follow-up functions were that the average VAS was 0.22(0-1),Constant-Murley score 79.7±6.5(71-91),the average range of shoulder joint anteflexion 118°±20°(90°-160°),abduction 95°±14°(75°-120°) and internal rotation L1.Conclusion:Treatment of proximal humeral fracture with the fracture line implicating upper humerus metaphysis and humeral shaft is difficult because the medial cortex is injured and the longitudinal fracture line involves bone shaft.A good selection of operative approach and careful operation guarantee postoperative function restoration.

关 键 词：肱骨骨折 骨折固定术 内 手术后并发症 骨骺 骨干 

分 类 号：R681.7[医药卫生—骨科学]