解剖锁定钢板结合异体腓骨髓腔内结构植骨治疗复杂肱骨近端骨折  

Anatomic locking plate strengthened with structural fibular allograft in medullar cavity treating complicated proximal humeral fracture

作　　者：石金柱[1] 黄强[2] 张玉富[2] Shi Jinzhu;Huang Qiang;Zhang Yufu(Deprtment of Orthopedics,The First Hospital of Fangshan District,Beijing,Beijing 102400,China;Department of Traumatology and Orthopaedic,Beijingjishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京市房山区第一医院骨科,102400 [2]北京积水潭医院创伤骨科,100035

出　　处：《中华肩肘外科电子杂志》2017年第4期272-277,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的探讨解剖锁定钢板结合异体腓骨髓腔内结构植骨治疗复杂肱骨近端骨折的疗效。方法回顾性分析北京积水潭医院创伤骨科,自2015年5月至2016年2月,应用锁定钢板固定结合同种异体腓骨段植骨治疗复杂肱骨近端骨折患者15例,其中11例获得最终随访。男3例,女8例;年龄52~76岁,平均69.5岁;采用Neer分型,均为三、四部分骨折,其中大结节三部分骨折6例,四部分骨折5例。采用Constant-Murley绝对值评分方法评价肩关节功能,90~100分为优,80~89分为良,70~79分为可,70分以下为差。结果随访时间4~22个月,平均13.5个月。末次随访患者时,平均Constant-Murley评分为82.3分(58~93分),优2例、良6例、可2例、差1例。肩关节活动度平均为前屈上举132.3°(65~170°),体侧外旋20.5°(10~35°),内旋T12-L3水平(L5-T9)。术后11例患者切口一期愈合,无感染、血管、神经等损伤,无异体腓骨排斥反应。X线片检查提示外科颈骨折均一期骨性愈合,无肱骨头高度丢失、骨折再次移位,其中1例患者出现肱骨头坏死,但无螺钉穿出,肩关节功能均恢复良好。另1例四部分骨折患者出现大结节骨块固定失效,向近端移位至肩峰下,肱骨头坏死及螺钉穿出,肩关节功能均恢复可。结论应用同种异体腓骨植入髓腔,术中能够帮助复位、维持复位,再结合锁定钢板固定,术后可以有效维持颈干角的固定,避免固定失效。Background Proximal humerus fracture is a common type of fracture.It was reported in 1980s that 80%to 85%of them were non-displaced or mild displaced fractures,and only 15%to 20%required surgery.However,with the advent of aging society,as a kind of osteoporotic fracture,it becomes more common and is treated surgically more often.Because of the obvious osteoporosis,there are some difficulties in reduction and maintenance during operation.It is even more difficult to deal with the failure of fixation,varus and screw cutting-out.The complicated three or 4-part fracture refers to the surgical neck fracture,accompanied by a large/small tuberosity fracture,which endangers the rotator cuff and the blood supply of the humeral head.surgical treatment should be taken because conservative treatment cannot achieve a satisfactory result.Some surgeons use fibula allograft as humeral intramedullary implants,which can contribute to the postoperative reduction,maintain stability,prevent the loss of reduction and fixation failure after surgery,and has a better effect for complicated comminuted fractures of the proximal humerus.

关 键 词：肱骨近端 锁定钢板 异体腓骨 

分 类 号：R687.3[医药卫生—骨科学]