锁定钢板结合异体腓骨支撑治疗老年肱骨近端Neer三、四部分骨折  

Proximal humeral internal locking system combined with fibular strut allograft for treatment of Neer 3- and 4-part factures of proximal humerus in the elderly

作　　者：张军[1] 庄云强[1] 李东贞 张亚弟 周龙[1] 姜刚强[1] Zhang Jun;Zhuang Yunqiang;Li Dongzhen;Zhang Yadi;Zhou Long;Jiang Gangqiang(Department of Orthopaedics,Ningbo No.6 Hospital,Ningbo,Zhejiang 315040,China)

机构地区：[1]宁波市第六医院骨科,315040

出　　处：《中华创伤骨科杂志》2018年第11期946-952,共7页Chinese Journal of Orthopaedic Trauma

基　　金：浙江省自然科学基金（LY18H06008）

摘　　要：目的比较肱骨近端锁定钢板（PHILOS）结合异体腓骨支撑与单纯PHILOS固定治疗老年肱骨近端Neer三、四部分骨折的疗效。方法回顾性分析宁波市第六医院骨科自2013年5月至2016年10月收治的157例老年肱骨近端Neer三、四部分骨折患者资料，男76例，女81例；年龄60—88岁，平均76．1岁。根据Neer分型：三部分骨折100例，四部分骨折57例。其中35例患者采用PHILOS结合异体腓骨支撑固定（A组），122例患者单纯采用PHILOS固定（B组）。末次随访时记录并比较两组患者肩关节活动度（前屈上举、外展、内旋、外旋）、疼痛视觉模拟评分（VAS）、美国肩肘外科医生评分（ASES）、Constant—Murley评分、术后肱骨头高度丢失、肱骨头内翻角度、并发症发生率及二次手术率等。结果157例患者术后获12～22个月（平均16．8个月）随访。A组、B组骨折愈合时间分别为（13．0±3．8）、（15．6±4．2）周，差异均有统计学意义（P〈0．05）。末次随访时A组、B组前屈上举分别为135．60±17．70、125．4°±23．6°，外展分别为132．5°±22．7°、117．5°±32．7°，外旋分别为30．2°±18．7°、21．6°±17．2°，内旋分别为T9、T11,VAS评分分别为（0．6±0．9）、（0．9±1．2）分，ASES评分分别为（90．2±6．8）、（82．2±12．3）分，Constant—Murley分别为（88．5±3．6）、（72±4．9）分，术后肱骨头高度丢失分别为0．9°±0．1°、4．2°±0．4°，肱骨头内翻角分别为1．2°±0．2°、4．5°±1．9°，以上项目两组间比较差异均有统计学意义（P〈0．05）。并发症发生率分别为14．28％（5／35）、22．13％（27／122），二次手术率分别为2．85％（1／35）、8．19％（27／122），差异均无统计学意义（P〉0．05）。结论PHILOS治疗老年肱骨近端骨折时，结合异体腓骨支撑固定，能给肱骨近端内侧柱及肱骨头提供良好的支撑，�Objective To compare proximal humeral interual locking system （PHILOS） combined with fibular strut allograft versus simple PHILOS for the treatment of Neer 3- and 4-part factures of proximal humerus in the elderly. Methods A retrospective study was conducted of 157 elderly patients with Neer 3- or 4-part facture of proximal humerus who had been treated at Department of Orthopaedics, Ningbo No. 6 Hospital from May 2013 to October 2016. They were 76 males and 81 females, aged from 60 to 88 years （average, 76. 1 years） . According to the Neer classification, 100 cases were 3-part fractures and 57 4-part fractures. Of them, 35 were treated by PHILOS combined with fibular strut a11ograft （group A） and 122 by PHILOS alone （group B）. At the last follow-up, the 2 groups were compared in terms of shoulder joint activity （anteflexion, abduction, internal rotation and external rotation）, visual analogue scale （VAS）, American Shoulder and Elbow Surgeons （ASES） score, Constant-Murley score, postoperative height loss of the humeral head, humeral head varus angle, complication rate and secondary surgery rate. Results The 157 patients were followed up for 12 to 22 months （mean, 16. 8 months）. The fracture healing time was 13.0 ± 3.8 weeks in group A and 15.6 ± 4.2 weeks in group B, showing a statistically significant difference （ P 〈 0.05）. At the last follow-up, for groups A and B respectively, anteflexion was 135.6° ± 17.7° versus 125.4° ±23.6°, abduction 132.5° ±22.7° versus 117.5°± 32. 7°, external rotation 30. 2° ± 18.7° versus 21.6° ± 17.2°, internal rotation T9 versus T11, VAS score 0. 6 ±0. 9 points versus 0. 9 ± 1.2 points, ASES score 90. 2 ±6. 8 points versus 82. 2 ±12. 3 points, Constant-Murley score 88.5±3.6 points versus 72 ±4. 9 points, postoperative height loss of the humeral head 0.9± 0. 1 mm versus 4. 2±0.4 mm, and humeral head varos angle 1.2°±0. 2° versus 4. 5°±1.9°. The differences between the 2 groups were all statistically significant

关 键 词：肩骨折 骨折固定术 内 骨板 老年人 异体腓骨 

分 类 号：R687.3[医药卫生—骨科学]