微创经皮钢板接骨术结合长型肱骨近端锁定板治疗骨质疏松性肱骨中上段骨折  

Minimally invasive techique with long proximal humeral locking plate for treatment of osteoporoticmiddle-proximal humeral shaft fractures

作　　者：杨立辉[1] 王瑞[1] 柳伟[1] 安立琨[1] 孔晓川[1] 李健[1] 洪刚[1] 朱文艺[1] 郭子城[1] 

机构地区：[1]首都医科大学北京朝阳医院京西院区骨科,100043

出　　处：《中华老年医学杂志》2013年第6期646-649,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨长型肱骨近端锁定板经肱骨外侧入路微创固定老年骨质疏松性肱骨中上段骨折的临床疗效。方法2010年2月至2012年1月使用长型肱骨近端锁定板经肱骨外侧人路微创固定治疗老年骨质疏松性肱骨中上段骨折。根据AO／OTA分型：B型5例，C型8例。术中记录手术时间，出血量。采用Constanv Murley肩关节评分标准，对患者健侧、患侧肩关节进行评分，同时计算患侧评分占健侧评分的百分比。结果手术时间（96．1±13．1）min，出血量（153．4±45．8）ml。13例伤口全部Ⅰ期愈合，全部病例均获随访，随访（10．5±3．1）个月，骨折愈合时间（11．7±1．8）周；骨折端无移位，螺钉无松动、拔出及断钉，无肱骨头坏死。末次随访时，患侧肩关节前屈上举活动度（155．7±9．7）°。患侧在末次随访时平均（81±6．0）分；患侧评分占健侧百分比（89．3--4-5．8）％；优良12例，满意1例，优良率为92．3％。结论微创经皮钢板接骨术结合长型肱骨近端锁定板外侧人路治疗肱骨中上段骨折可以提供稳定的固定，损伤小，可早期功能锻炼，骨折愈合率较高，更适合于粉碎性或骨质较差的肱骨干骨折。Objective To evaluate the clinical effect of minimally invasive techique with the long proximal humeral locking plate on the treatment of osteoporotic middle-proximal humeral shaft fractures. Methods From February 2010 to January 2012, a total of 13 patients with osteoporotic middle-proximal humeral shaft fractures were treated with internal fixation by using the long proximal humeral locking plate. According to AO/OTA classification, 5 cases were in B type and 8 cases were in C type. The operation time and bleed volume were recorded. The contralateral and ipsilateral shoulder function was assessed by Constant-Murley shoulder assessment score and percentage of ipsilateral shoulder assessment scores on contralateral shoulder assessment scores was calculated. Results The mean operative time was （96.1 ±13. 1）rain and bleed volume was （153.4±45.8）ml. 13 patients were followed up for （10.5±3.1）months. The cut wounds in all patients were healed at the primary stage. The mean fracture healing time was （11.7 ± 1.8）weeks. No complications such as fracture displacement, screw loose and pullout, broken nails and necrosis of the humeral head were found. At the last follow-up, the mean range of motion （ROM）in ipsilateral shoulders was （155.7 ± 9.7） ° and the average Constant-Murley scores in ipsilateral shoulders were （81 ±6.0）. The percentage of ipsilateral shoulder assessment scores on contralateral shoulder assessment scores was （89.3± 5.8） %. 12 patients were with excellent or good shoulder function and 1 patient was with satisfactory function after treatment. The excellent and good rate was 92.3% （12/13 cases）. Conclusions Internal fixation using the long proximal humeral locking plate can provide the stable fixation with a minimal invasion and high rate of fracture repair, and has advantage in early functional exercise for the treatment of osteoporotic middle-proximal humeral shaft fractures, which is more suitable for humeralshaft comminuted or weak bone fracture.

关 键 词：肩骨折 外科手术 微创性 骨质疏松 老年性 

分 类 号：R687.3[医药卫生—骨科学]