肱骨髓内钉治疗肱骨近端骨折的疗效与体会  

Curative effect observation and application experience of intramedullary nailing for displaced proximal humeral fractures

作　　者：王艳华[1] 张晓萌[1] 付中国[1] 陈建海[1] 党育[1] 杨明[1] 张殿英[1] Wang Yanhua;Zhang Xiaomeng;Fu Zhongguo;Chen Jianhai;Dang Yu;Yang Ming;Zhang Dianying(Department of Trauma and Orthopeadics,Peking University People's Hos pital,Peking Univer sity,Traffic Medicine Center,Beijing 100044,China)

机构地区：[1]北京大学人民医院创伤骨科,北京大学创伤医学中心,100044

出　　处：《中华肩肘外科电子杂志》2017年第2期113-118,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：教育部创新团队发展计划(IRT1201);国家自然科学基金(31640045);国家自然科学基金(31071246);国家重点研发计划项目(2016YFC1101604);北京大学人民医院发展基金(RDY2016-07)

摘　　要：目的探讨肱骨近端髓内钉治疗有移位肱骨近端骨折(Neer分型二部分、三部分骨折)的疗效。方法回顾性分析2012年10月至2014年12月北京大学人民医院创伤骨科采用髓内钉治疗且获得完整随访的21例肱骨近端骨折患者,其中Neer分型二部分骨折12例,三部分骨折9例。分别记录患者手术时间、术中出血量和手术并发症,采用Constant评分评价肩关节功能。结果随访时间最短7个月,最长37个月,平均随访时间为17.45个月。所有患者骨折均愈合。平均手术时间为71.67 min,术中平均出血量为70.48 ml。末次随访平均肩关节疼痛评分0.52分。骨折平均愈合时间为4.24个月,肩关节活动平均活动范围:前屈135.24°,外展130.24°,内旋33.33°,外旋50.71°。术后平均肩关节Constant-Murley评分为82.48分,其中优2例、良15例、可3例、差1例,优良率为80.95%。1例延迟愈合、1例术后肩痛、1例伤口渗液不愈合。结论采用髓内钉治疗肱骨近端二部分和三部分骨折创伤小、固定牢固、可允许术后早期进行功能锻炼,关节功能恢复好,是治疗肱骨近端骨折的有效手段之一。Background Proximal humeral fractures refer to the fractures involving neck and above,which is a common upper limb fracture clinically.Non-displaced proximal humeral fractures are often treated conservatively.Currently,the locking plate fixation is often used for displaced 2-Part,3-Part and some of the 4-Part proximal humeral fractures of Neer classification.Since locking plate fixation is eccentric and belong to the extramedullary fixation,complications such as fracture reduction loss,screw cutting out and ischemic necrosis of humeral head often appear in the treatment of osteoporotic fractures and proximal humeral fractures with large displacement.Meanwhile,several domestic and foreign literatures reported that the intramedullary nailing has its own advantages in the treatment of proximal humeral fractures including minimally invasive,small impact on the local blood supply of fractures and reliable fixation.This article summarized the curative effect and experiences of treating proximal humerus fractures with intramedullary nail.Methods(1)General data.From October 2012 to December 2014,23 cases of proximal humerus fractures were treated with proximal humeral nail in our department.21 cases were followed up,including 10 males and 11 females.The age ranged from 41 to 78 years with an average of 56 years.X-ray and 3D CT scan&reconstruction were performed preoperatively for severity evaluation.According to the Neer classification,12 cases of 2-Part fractures and 9 cases of 3-Part fractures were involved,including 1 case of combined shoulder joint dislocation and 2 cases of combined rotator cuff injury.The Multiloc proximal humeral intramedullary nail of Synthes company and the Trigen intramedullary nail of Smith&Nephew Co Ltd.were used intraoperatively for fracture fixation.(2)Operative methods.After successful general anesthesia,the patient was put into beach chair position.Then,the operative area was routinely disinfected with iodine and alcohol and draped.The affected shoulder joint was fully exposed,and a 3-4 c

关 键 词：骨折 肱骨近端 髓内钉 手术 

分 类 号：R687.3[医药卫生—骨科学]