一期植骨在锁定钢板治疗嵌插型肱骨近端骨折中的临床意义  

Fracture site augmentation with cancellous allograft bone in locked plating for impacted proximal humerus fractures

作　　者：唐三元[1] 陈云丰[2] 曾浪清[1] 杨辉[1] 魏海峰 张闻[2] 唐天华[1] 

机构地区：[1]暨南大学附属珠海医院,广东省珠海市人民医院创伤骨科,519000 [2]上海交通大学附属第六人民医院骨科

出　　处：《中华创伤骨科杂志》2014年第10期843-847,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨一期植骨在锁定钢板治疗嵌插型肱骨近端骨折术中的临床意义，方法 回顾性分析2005年6月至2013年2月采用锁定钢板治疗且获得完整随访的39例嵌插型肱骨近端骨折患者资料,男13例,女26例;年龄22～81岁,平均58.8岁。骨折均为嵌插型,根据Neer分型：二部分骨折15例,三部分骨折15例,四部分骨折9例，术中一期植异体松质骨20例（植骨组）,未植骨19例（未植骨组），记录并比较两组患者的肩关节Constant评分、相对健侧Constant评分、疼痛视觉模拟评分（VAS）、肱骨头高度丢失及并发症发生情况等， 结果 39例患者术后获12 ～36个月（平均18.5个月）随访，植骨组与未植骨组患者平均Constant评分分别为（77.2±11.7）、（68.7±l3.8）分,相对健侧Constant评分分别为83.9％±10.4％、74.3％±l2.8％,平均疼痛VAS评分分别为（1.9±2.1）、（3.2±1.8）分,植骨组患者术后肱骨头高度丢失[（1.1±1.3）mm]明显小于未植骨组[（3.3±4.0） mm],以上项目两组间比较差异均有统计学意义（P＜0.05），植骨组患者术后并发症发生率（20.0％）、二次手术率（10.0％）均低于未植骨组（42.1％、21.1％）,以上项目两组间比较差异均无统计学意义（P＞0.05）， 结论 锁定钢板内固定治疗嵌插型肱骨近端骨折,术中一期植异体松质骨不仅能使肱骨头得到有效的支撑、减少术后肱骨头高度的丢失及相关并发症的发生,而且能获得更满意的临床疗效。Objective To evaluate the clinical benefits of fracture site augmentation with cancellous allograft bone in locked plating for impacted proximal humerus fractures.Methods A retrospective analysis was conducted of the eligible 39 patients with impacted proximal humerus fracture who had undergone locking plate fixation in our institution between June 2005 and February 2013.They were 13 men and 26 women,22 to 81 years of age （average,58.8 years）.By the Neer classification,there were 15 cases of two-part fracture,15 cases of three-part fracture and 9 cases of four-part fracture.Of this cohort,20 patients had their humeral head defects augmented with allogenous cancellous chips in the primary operation while the other 19 patients did not.The postoperative Constant scores of the affected shoulder and the contralateral shoulder,visual analog scale （VAS） pain scores,humeral head height loss and complications were compared between the 2 groups.Results The patients obtained a mean follow-up of 18.5 months （range,from 12 to 36 months） The clinical outcomes in the augmentation group were significantly better than in the non-augmentation group in terms of Constant score of the affected shoulder （77.2 ± 11.7 vs.68.7 ± 13.8）,Constant score of the contralateral shoulder （83.9％ ± 10.4％ vs.74.3 ± 12.8％）,VAS pain score （1.9 ±2.1 vs.3.2±1.8）,and humeral head height loss （1.1 ±1.3 mm vs.3.3±4.0mm） （P ＜0.05）.For the augmentation group,the complications rate （20.0％） and secondary operation rate （10.0％） were both insignificantly lower than those for the non-augmentation group （42.1％ and 21.1％,respectively） （P ＞ 0.05）.Conclusion In the locked plating of impacted proximal humerus fractures,augmentation of the humeral head defects with cancellous chips may render benefits of enhancing mechanical stability of the humeral head,maintaining fracture reduction,reducing humeral head height loss and complications to ensure good clinical outcomes.

关 键 词：肩骨折 骨折固定术 内 接骨板 异体松质骨植骨 

分 类 号：R687.3[医药卫生—骨科学]