三种手术方式治疗Neer Ⅲ-Ⅳ部分肱骨近端骨折的比较  

Comparison of three surgical techniques for the treatment of Neer grade Ⅲ-Ⅳ proximal humeral fractures

作　　者：王礼宁 王强[2] 沈婧鈺 黄河[2] 常鹏飞 郭杨[3] 马勇[3] WANG Li＇ning;WANG Qiang;SHEN Jing-yu;HUANG He;CHANG Peng-fei;GUO Ya;MA Yong(Department of Ortho,pedics,Nanjing First Hospital,Nanjng Medical University,Nanfing 210006,China;Nanjing University of Chinese Medicine,Nanjing 210023,China;Department of Orthopedics,Affiliated Hospital to Nanjing University of Chinese Medicine,Nanjing 210029)

机构地区：[1]南京中医药大学,江苏南京210023 [2]南京医科大学附属南京医院(南京市第一医院)骨科,江苏南京210006 [3]南京中医药大学附属医院骨伤科,江苏南京210029

出　　处：《中国矫形外科杂志》2018年第22期2038-2043,共6页Orthopedic Journal of China

摘　　要：[目的]比较外侧锁定加内侧辅助钢板与单纯外侧锁定钢板、人工半肩关节置换治疗NeerⅢ-Ⅳ部分肱骨近端骨折的疗效。[方法]回顾性分析2015年11月～2017年1月本科诊治的NeerⅢ-Ⅳ部分肱骨近端骨折53例,其中17例采用外侧锁定加内侧辅助钢板内固定(双钢板组),21例采用单纯外侧锁定钢板固定(单钢板组),15例采用人工半肩关节置换(关节置换组)。比较三组患者的临床与影像资料。[结果]双钢板组在手术时间上长于其余两组,差异有统计学意义(P<0.01),但在术中出血量及切口长度上三组差异无统计学意义(P>0.05)。术后1、3个月双钢板组和单钢板组的Neer评分低于关节置换组,差异有统计学意义(P<0.01);但术后6个月时,三组评分差异无统计学意义(P>0.05);而术后12个月时,双钢板组和单钢板组的Neer评分均高于关节置换组,且差异有统计学意义(P<0.01)。在影像测量方面,肱骨头内翻角和肱骨头高度丢失值在双钢板组和单钢板组均随术后时间延长而增加,不同时间点间差异有统计学意义(P<0.05);双钢板组上述变化显著小于单钢板组,表现为术后1个月和3个月上述影像指标两组间差异无统计学意义(P>0.05),但术后6个月和12个月两组间差异有统计学意义(P<0.05)。[结论]锁定加内侧辅助钢板技术是治疗NeerⅢ-Ⅳ部分肱骨近端骨折的有效方式之一。[Objective]To compare the clinical outcomes of lateral locking plate combined with medial plate, lateral locking plate only and shoulder hemiarthroplasty for Neer grade Ⅲ-Ⅳ proximal humeral fractures, [Methods] A retrospec. tire study was done on 53 patients who underwent surgical treatment for Neer grade Ⅲ-Ⅳ proximal humeral fractures from November 2015 to January 2017 in our hospital. Of them, 17 patients had fractures fixed with lateral locking plate combined with medial plate （the double plates group）, whereas 21 received internal fixation with lateral locking plate only （single plate group）, and 15 patients underwent shoulder bemiarthroplasty （the arthroplasty group）. The clinical and radiographic data were compared among the 3 groups. [Results] The double plates group consumed statistically longer operation time than other two groups （P〈0.05）, although no statistically significant differences among the 3 groups regarding to intraoperative blood loss and incision length （P〉0.05）. Neer scores in both the double plates group and single plate group at 1 and 3 months postopera tively were statistically less than that in the arthroplasty group （P〉0.05）, which turned to be no statistically significant among the 3 group at 6 months （P〉0.05）, conversely to be statistically significantly higher in both the double plates group and single plate group than the arthroplasty group at 12 months after operation （P〈0.05）. In term of radiographic measures, both the humeral head varus angle and height loss significantly increased over time with statistical differences among different time points （P〈 0.05）. Those variations were significantly less remarkable in the double plates groups than the single plate group with statistically significant differences at 6 and 12 months （P〈0.05）, despite no statistical differences at 1 and 3 months between the two groups （P〉0.05）. [Conclusion] Lateral locking plate combined with medial plate is one of the effective methods

关 键 词：肱骨近端骨折 锁定加内侧辅助钢板 半肩关节置换 肩关节Neer评分 内侧柱支撑 

分 类 号：R683.41[医药卫生—骨科学]