Multiloc髓内钉内固定治疗Neer二、三部分肱骨近端骨折的疗效分析  

Multiloc intramedullary nail for treatment of two and three parts of proximal humeral fractures

作　　者：张伟[1] 逸弘 崔胜宇[1] 时欣[1] 杨健[1] 刘巍[1] 朱新辉[1] ZHANG Wei;YI Hong;CUI Sheng-yu;SHI Xi;YANG Jian;LIU Wei;ZHU Xin-hui(Department of Orthopaedic,Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)

机构地区：[1]南通大学第二附属医院骨科,江苏南通226001

出　　处：《中国骨与关节损伤杂志》2018年第7期693-696,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨Multiloc髓内钉内固定治疗Neer二、三部分肱骨近端骨折的早期临床疗效。方法回顾性分析自2016-08—2017-02采用Multiloc髓内钉内固定治疗的13例Neer二、三部分肱骨近端骨折。比较术后1、6个月疼痛VAS评分、肩关节功能Constant评分、前屈上举活动度、主动体侧外旋活动度及肱骨颈干角。结果 13例均获得随访,随访时间平均8.7(6~14)个月。末次随访时骨折均获得骨性愈合,骨性愈合时间平均15.7(12~20)周。随访期间未出现内固定物断裂、肩峰下撞击、肱骨头缺血性坏死、内翻畸形愈合和螺钉切出等并发症。术后6个月时疼痛VAS评分、肩关节功能Constant评分、前屈上举活动度、主动体侧外旋活动度较术后1个月时明显改善,但出现肱骨颈干角丢失,差异有统计学意义(P<0.05)。术后6个月肩关节功能Constant评分:优2例,良9例,可2例。结论 Multiloc髓内钉内固定治疗Neer二、三部分肱骨近端骨折在骨折愈合、肩关节功能恢复和减少并发症方面可取得满意的效果,但是髓内钉手术操作难度大,学习曲线长,术者应熟练掌握髓内钉操作指南。Objective To evaluate the early clinical outcome of Multiloc intramedullary nail in the treatment of two and three parts of proximal humeral fractures. Methods From August 2016 to February 2017, 13 cases of Neer two and three parts of proximal humeral fractures treated with Multiloc intramedullary nails were retrospectively analyzed. The VAS scores, shoulder joint functional Constant scores, forward flexion, active body side external rotation and the humeral neck angles were compared between 1 month and 6 months after surgery. Results All of the 13 patients were followed up for an average of 8.7 months（from 6 to 14 months）. At the last follow-up, all of the cases obtained bone union, in an average of 15.7 weeks（from 12 to 20 weeks）. There were no complications of internal fixator breakage, subacromial impingement, humeral head avascular necrosis,varus deformity and screw cut out. Compared with 1 month after operation, the VAS scores, Constant scores, forward flexion,active body side external rotation were significantly improved, but the average of humeral neck angle was decreased at 6-month follow-up（P〈0.05）. According to Constant scores assessment, 2 cases were excellent, 9 good, 2 fair. Conclusion Multiloc intramedullary nail for treatment of two and three parts of proximal humeral fractures were satisfactory in bone union, recovery of shoulder joint function and low complications. But, the application of Multiloc intramedullary nail is difficult and requires a long learning curve. Surgeon should be proficient in its operating process.

关 键 词：Neer二、三部分肱骨近端骨折 Multiloc髓内钉 Calcar螺钉 内固定 内翻畸形 

分 类 号：R687.3[医药卫生—骨科学]