同种异体骨移植在骨质疏松性肱骨近端骨折中的临床应用研究  

Clinical research on allograft bone transplantation in the treatment of osteoporotic proximal humeral fracture

作　　者：曹烈虎[1] 翁蔚宗[1] 陈晓[1] 周启荣[1] 张军[1] 汪琳[1] 王尧[1] 纪方[1] 苏佳灿[1] Cao Liehu;Weng Weizong;Chen Xiao;Zhou Qirong;Zhang Jun;Wang Lin;Wang Yao;Ji Fang;Su Jiacan(Department of Orthopedics and Traumatology, Changhai Hospital of Second Military Medical University of Chinese PLA, Shanghai 200433, China)

机构地区：[1]第二军医大学附属长海医院创伤骨科,上海200433

出　　处：《中华肩肘外科电子杂志》2018年第1期11-18,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：上海市自然科学基金(15ZR1412500);国家自然国际合作基金(8141101156);上海市科委生物医药专项(154119500600)

摘　　要：目的探讨采用同种异体骨移植在骨质疏松性肱骨近端不同类型骨折中的应用价值。方法回顾性分析2007年5月至2013年6月,第二军医大学附属长海医院创伤骨科收治的36例患者,其中男17例,女19例,年龄65~82岁,平均(71.5±5.5)岁;致伤原因:摔伤25例,车祸外伤7例,运动伤4例。合并肩关节脱位4例,肋骨骨折3例,锁骨骨折1例。根据Neer分型:外科颈或解剖颈二部分骨折14例,三部分骨折13例,四部分骨折9例。所有患者均采用切开复位锁定钢板内固定治疗联合同种异体骨植入。术后采用Constant评分、加利福尼亚大学洛杉矶分校(University of California,Los Angeles,UCLA)肩关节评分、视觉模拟评分(visual analogue scale,VAS)以及相关并发症进行评价和影像学评价。结果所有患者术后获6~36个月(平均31.6个月)随访,34例患者获骨性愈合,骨折愈合时间(5.5±0.7)个月(3~9个月),未出现同种异体骨排异反应。术后1年末次随访,二、三、四部分颈干角分别为129°±5°(121~135°)、128°±3°(111~140°)、121°±4°(110~134°),四部分骨折颈干角明显低于二、三部分骨折,差异具有统计学意义(P<0.01);二、三、四部分肱骨头高度分别丢失(1.7±0.4)mm(1.2~2.7 mm)、(1.8±0.3)mm(1.3~3.1 mm)、(1.9±0.5)mm(1.4~3.5 mm),三组之间差异无统计学意义(P>0.05);二、三、四部分疼痛VAS评分分别为(1.7±0.8)分(1~3分)、(1.5±0.5)分(1~3分)、(1.4±0.3)分(1~3分),三组之间差异无统计学意义(P>0.05);但二、三、四部分功能Constant评分分别为(82.0±4.2)分(52~90)分、(78.0±3.6)分(57~91分)、(63.0±3.8)分(55~89分),UCLA评分分别为(31.3±2.1)分(27~35分)、(30.2±1.5)分(26~33分)、(27.6±1.6)分(23~31分),二、三部分肩关节功能明显优于四部分骨折,差异有统计学意义(P<0.01)。7例患者出现相关并发症,并发症发生率19.4%。结论同种异体骨移植治疗骨质疏松性肱骨近端二、三部分骨折,使肱骨头得到有效的支�Background Accounting for5%of all fractures,proximal humerus fracture is one of the most common fractures for osteoporotic group with an incidence of90.9/100000per year.Its incidence rate increases with age,and approximately70%of proximal humeral fractures occur in patients over60years old.F emale accounts for the m ajority of the affected elderly over80years old,as the ratio between men and women is3:7.With obvious displacement and osteoporosis,bone compression and loss are easily formed after fracture,which result in the loss of the unique anatomical mark of humeral neck.The therapeutic effect of conservative treatment for displaced fracture is unsatisfactory.The displacement even causes great difficulty in plate fixation during surgery,which easily triggers complications such as loss of reduction,ischemic necrosis,screw piercing,etc.For osteoporotic proximal humeral fracture,locking plate fixation has the advantages of multi-angle and stable fixation,which can significantly improve postoperative function and reduce complications.However,the complications caused by locking plate still happen.According to the literature,the rate of humeral head bone loss and screw piercing is still as high as29%with the bone loss of about6mm.Allograft bone transplantation can provide good support for humeral head and promote fracture healing,and the clinical effect is satisfactory.Although locking plate fixation with allogeneic bone graft has been applied for the treatment of senile osteoporotic proximal humeral fracture,the clinical efficacy evaluation and imaging data analysis of different types have been barely reported.Therefore,this article aims to explore the application value of allograft bone transplantation in different types of osteoporotic proximal humerus fracture.Methods(1)General information.A total of36patients(17males and19females)were included in this study,and the age ranged from65to82years with an average of(71.5±5.5)years.The causes of injury include25cases of fall damage,7cases of traffic accident and4cases

关 键 词：骨折 肱骨近端 内固定 同种异体松质骨 

分 类 号：R687.3[医药卫生—骨科学]