非手术与手术治疗肱骨近端骨折  

Non-operative and surgical treatment for proximal humeral fracture

作　　者：范亚杰[1] 马张稳[1] FAN Ya-jie MA Zhang- wen(Dept of Orthopaedics, The Affiliated Hospital of Yan＇an University,Yan＇an,Shanxi 716000, China)

机构地区：[1]延安大学附属医院骨科,陕西延安716000

出　　处：《临床骨科杂志》2017年第5期578-581,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较非手术治疗与髓内钉手术治疗肱骨近端三部分和四部分骨折的疗效。方法将49例肱骨近端Neer三、四部分骨折患者按治疗方法分为两组:20例采用非手术治疗,29例采用髓内钉治疗。采用Neer评分评估两组术后肩关节功能,并比较两组优良率。结果患者均获得随访,时间12~36个月。Neer评分:非手术治疗组平均(77.5±4.5)分,优良率为14/20;髓内钉治疗组平均(76.0±5.1)分,优良率为21/29;两组优良率比较差异无统计学意义(P>0.05)。三部分骨折术后肩关节活动度:非手术组前屈、外展、内旋优于髓内钉治疗组,差异均有统计学意义(P<0.05);非手术组四部分骨折的外展与髓内钉组比较差异有统计学意义(P=0.000)。其余项目活动度两组差异均无统计学意义(P>0.05)。两组均未出现肱骨头缺血坏死。髓内钉组有4例内翻愈合,2例外翻愈合,无假关节形成;非手术组2例内翻愈合,1例外翻愈合,1例假关节形成;两组并发症比较差异无统计学意义(P>0.05)。结论 Neer三、四部分肱骨近端骨折采用髓内钉手术治疗或非手术治疗均能获得良好效果,掌握骨折分型和手术技巧并实行个体化治疗方案对术后功能至关重要。Objective To compare the effects of non-operation and intramedullary nail in treatment of threeor fourpart proximal humerus fractures. Methods The 49 patients with proximal humerus Neer three-or four-part fractures were divided into two groups according to the treatment methods, 20 patients received non-operative treatment and 29 patients were treated with intramedullary nail. The Neer-score was used to evaluate shoulder function and the excel- lent-good rate was compared in two groups. Results All patients were followed up from 12 months to 36 months. The result of two groups in Neer-score ： non-operative treatment group was （77.5 ± 4.5） points, excellent-good rate was 14/20, and intramedullary nail group was （76 ± 5. 1 ） points, excellent-good rate was 21/29, there was no sig- nificant difference between the two groups about the excellent-good rate（P 〉0. 05 ）. There was significant difference in the degree of postoperative joint movement between the two groups for flexion, abduction, internal rotation in three- part fractures（P 〈0. 05 ）, and the non-operative group was better than intramedullary group; there was significant difference in the abduction of the two groups of four-part fractm＇es （P = 0. 000）. There was no significant difference in the degree of activity of the remaining items （P 〉 0. 05 ）. No humeral head necrosis occurred in both groups, the intramedullary nail group had 4 cases of varus healing, 2 cases of valgus healing, no pseudarthrasis formation; non- operative group had 2 cases of varus healing, 1 case of valgus healing, 1 case of pseudarthrosis formation. There was no significant difference about the complication between the two groups （P 〉 0. 05）. Conclusions The Neer three- or four-part proximal humerus fractures can be treated by intramedullary nail or non-operative treatment,they can get good results. It is critical to mastering the experience of fracture typing and surgical techniques and implementing individualized treatment for function progn

关 键 词：肱骨近端骨折 Neer评分 非手术治疗 髓内钉 

分 类 号：R683.41[医药卫生—骨科学] R687.33[医药卫生—外科学]