锁定钢板辅助肩袖缝合固定对老年性肱骨近端骨折的疗效探讨  

Locking plates with supplemental suture fixation of rotator cuff in the treatment of proximal humerus fractures in elderly patients

作　　者：金涛[1] 向选平[1] 许维亚[1] 梁杰[1] 雷军[2] 吴红艳[3] 

机构地区：[1]三峡大学人民医院骨科,湖北宜昌443000 [2]武汉大学中南医院,湖北武汉430071 [3]三峡大学医学院,湖北宜昌443002

出　　处：《中国矫形外科杂志》2015年第18期1643-1648,共6页Orthopedic Journal of China

摘　　要：[目的]通过测量肱骨头高度丢失及Neer评分比较,探讨肱骨近端内侧支撑重建和辅助肩袖缝合固定在锁定板治疗老年性肱骨近端骨折中的重要作用。[方法]回顾性分析2008年7月~2013年11月采用锁定板治疗的55例老年性肱骨近端骨折患者临床资料。根据是否辅助肩袖缝合固定及有无肱骨近端内侧支撑分为4组。A组：无肩袖缝合固定且无肱骨近端内侧支撑;B组：无肩袖缝合固定,但有肱骨近端内侧支撑;C组：有肩袖缝合固定,但无肱骨近端内侧支撑;D组：有肩袖缝合固定且有肱骨近端内侧支撑。测量随访时肱骨头高度丢失及评价术后肩关节功能,分析肱骨近端内侧支撑重建和肩袖缝合固定在骨折术后复位维持及功能恢复中的作用。[结果]55例患者随访13~33个月,平均17个月。A组7例,B组12例,C组15例,D组21例。术后3个月A组肱骨头高度丢失为（5.94±2.46）mm,明显高于B组（2.42±0.77）mm、C组（2.43±0.82）mm和D组（1.60±0.66）mm,差异有统计学意义（P〈0.05）;B、C组相比差异无统计学意义（P〉0.05）,但B、C组术后3个月肱骨头高度丢失明显高于D组（P〈0.05）。术后3~12个月A组肱骨头高度丢失（2.27±1.31）mm高于B组（0.52±0.40）mm、C组（0.53±0.29）mm、D组（0.50±0.31）mm,差异有统计学意义（P〈0.05）,B、C、D组组间差异无统计学意义（P〉0.05）。末次随访时B、C、D组Neer评分优于A组,D组优于B、C组,差异有统计学意义,B、C组间差异无统计学意义。[结论]肱骨近端内侧支撑重建和肩袖缝合固定对于维持肱骨近端骨折术后复位有着重要作用,两者结合锁定板固定对于老年性肱骨近端骨折疗效满意。[ Objective] By measuring the height loss of humeral head and contrasting the Neer score of each group,to ex- plore tire importance of medial support reconstructions and suture fixation of rotator cuff combining with locking plate in the treatment of aged patients with displaced proximal humeral fracture. [ Method] From July 2008 to November 2013,55 cases with displaced proximal humeral fracture undergoing open reduction and internal fixation with locking plates were retrospectively ana- lyzed. Based on the applying of suture fixtion （SF） and medial support （MS） or not, all cases were divided into 4 groups ： Group A （ SF - MS - ）, Group B （ SF - MS ＋ ） , Group C （ SF ＋ MS - ） , and Group D （ SF ＋ MS ＋ ）. Patients received complete follow - up included 7 cases in Group A, 12 cases in Group B, 15 cases in Group C,and 21 cases in Group D. By measuring the height loss of humeral head and evaluating the shoulder function, the importance of medial support reconstructions and suture fixation of rotator cuff was evaluated for the maintenace of bone reduction and post - operative shoulder functional recovery. [ Result] Fifty - five cases were followed up for 13 - 33 months （ mean 17 months）. At 3 months postoperatively, the average height loss of hu- meral head was（5.94 ± 2.46） mm in Group A,it was statistically higher than（2.42 ± 0. 77 ）mm in Group B, （2.43 ± 0. 82 ） nun in Grnup C ,and（ 1.60 ±0.66）mm in Group D, with significant difference（ P 〈 0.05 ）. The height loss of humeral head in Group B and Group C was statistically higher than in Group D（ P 〈 0.05 ） ,but there was no significant difference between Group B and C（ P 〉 0. 05 ）. From the third months to twelfth months postoperatively, the average height loss of humeral head was（2.27 ± 1.31 ）mm in Group A, it was statistically higher than（0.52 ± 0. 40）mm in Group B, （0.53 ± 0.29 ）mm in Group C, and（ 0.50 ±0.31 ）mm in Group D,with significant difference（ P 〈0. 05 ） ,

关 键 词：肩 肱骨近端骨折 锁定板 内固定 

分 类 号：R687.3[医药卫生—骨科学]