锁定钢板固定联合异体腓骨髓内移植治疗老年肱骨近端Ⅲ、Ⅳ部分骨折的临床疗效分析  

Locking plate fixation combined with intramedullary fibular allograft for three-and four-part proximal humeral fractures in elderly patients

作　　者：陈孝均[1] 王亮[2] 牟晓庆[3] 邹永根[1] 贺智榆 杨杰翔[1] 陶源[1] 罗成[1] 

机构地区：[1]泸州医学院附属中医医院骨伤科,四川646000 [2]泸州医学院附属中医医院急诊外科,四川646000 [3]泸州医学院附属医院放射科,四川646000

出　　处：《创伤外科杂志》2014年第4期339-343,共5页Journal of Traumatic Surgery

摘　　要：目的探讨采用锁定钢板固定联合同种异体腓骨段髓内移植治疗老年肱骨近端NeerⅢ、Ⅳ部分骨折的临床疗效。方法回顾性分析2011年1月-2012年10月,采用锁定钢板固定联合同种异体腓骨段髓内移植治疗老年肱骨近端NeerⅢ、Ⅳ部分骨折且随访完整的20例患者临床资料。男性8例,女性12例;年龄60-75岁,平均（67.2±4.3）岁;Ⅲ部分骨折11例,Ⅳ部分骨折9例,均有不同程度骨质疏松。术后根据影像学资料评价骨折愈合、颈干角和肱骨头高度;采用肩臂手功能障碍评分（DASH）、简明健康调查量表（SF-36）、Neer＇s评分评判肩关节功能。结果 20例均获随访12-24个月,平均（17.2±2.4）个月。术后切口均Ⅰ期愈合,无血管、神经损伤等并发症。骨折均愈合,无大、小结节再移位,无肱骨头移位或坏死发生,无螺钉松动、拔出、切割等并发症。术中颈干角平均为136.5°±2.1°（132.4°-139.7°）;末次随访颈干角平均为134.2°±1.0°（129.8°-136.9°）,较术中略有丢失。术后1年,DASH评分平均13.0±0.5（2.0-56.0）,SF-36评分平均86.0±0.9（30.0-97.0）;肱骨头高度丢失平均为2.5±0.4mm（1.5-4.8mm）;被动前屈平均150°±5.7°,主动前屈平均135°±3.7°,外旋平均55°±3.7°,内旋平均18°±2.1°。肩关节功能根据Neer＇s评分评定：优10例,良6例,可3例,差1例,优良率80.0%。结论采用锁定钢板固定联合同种异体腓骨段髓内移植治疗老年肱骨近端NeerⅢ、Ⅳ部分骨折,能够有效复位和稳定移位骨折块,并增强内侧柱的支撑,尤其是在骨质疏松的老年患者中,可以明显地减少术后内固定失败（如螺钉松动、切割）的发生。Objective To analyze the clinical results of locking plate fixation associated with intramedullary fibular allografi for three-and four-part proximal humeral fractures in elderly patients. Methods From Jan. 2011 to Oct. 2012,20 elderly patients with three-and four-part proximal humeral fractures were treated by locking plate fixation associated with intramedullary fibular allograft. The clinical data were retrospectively analyzed. There were 8 males and 12 females with an average age of 67.2 ± 4. 3 years （range ,60-75 years）. There were 11 cases of three-part proximal humeral fractures ,9 cases of four-part proximal humeral fractures. All patients had different degrees of osteoporosis. The imaging data were used to judge the fracture healing, and to measure the neck-shaft angle and the height of humeral head. Disability of Arm, Shoulder and Hand （DASH） , MOS 36-Item Short-Form Health Survey （ SF-36 ） and Neer＇s score were used to evaluate the function of the shoulder after surgery. Results Primary healing of incision was obtained in all patients without complications of vascular nerve injury. Twenty cases were followed up for 12-24 months（ mean, 17.2 ± 2. 4 months）. There were no complications such as re-displacement, necrosis,and loosening or screws cutting. At the last follow-up, the neck-shaft angle was 134. 2° ± 1. 0°（ range, 129.8 °- 136.9 ° ）, showing no significant difference （ P 〉 0.05 ） when compared with the intraoperative angle （ 136. 5 ° ± 2. 1 °on average,range, 132. 4°-139. 7°）. At I year after surgery, the mean DASH score was 13.0 ± 0. 5 （2. 0 - 56. 0 ）, the mean total SF-36 score was 86. 0 ± 0. 9 （range, 30. 0-97.0）, and the average loss in the height of humeral head was 2. 5 ±0.4 mm（range, 1.5 -4. 8 mm）. Patients had 150° ± 5.7° of passive forward flexion on arerage, 135 ° ± 3.7° of active forward flexion ,55 ° ± 3.7 ° of external rotation, and 18° ＋ 2. 1° of internal rotation. According to the Neer＇s score for shoulder fun

关 键 词：肱骨近端骨折 腓骨移植 骨质疏松 钢板 老年 

分 类 号：R683.41[医药卫生—骨科学]