单纯锁定钢板与联合植骨治疗肱骨近端Neer三部分骨折的比较  

Locking plate with or without bone graft for Neer 3-part proximal humeral fractures

作　　者：赵晓东[1] 吴月明 赵志钢[1] 张阿丽[1] ZHAO Xiao-dong;WU Yue-ming;ZHAO Zhi-gang;ZHANG A-li(The 89th Hospital of PLA,Weifang 261021,China;Haifushan Hospital of Lin qu County,Weifang 262605,China)

机构地区：[1]中国人民解放军第八十九医院,山东潍坊261021 [2]临朐县海浮山医院,山东潍坊262605

出　　处：《中国矫形外科杂志》2019年第22期2050-2054,共5页Orthopedic Journal of China

摘　　要：[目的]探讨锁定钢板联合植骨术治疗肱骨Neer三部分骨折的临床特点及治疗效果。[方法]回顾2011年1月~2017年1月本科手术治疗77例肱骨近端Neer三部分骨折患者。男性26例,女性51例,年龄(68.30±5.62)岁。按手术方法分为3组,其中,24例采用单纯锁定钢板内固定(单纯钢板组),30例采用锁定钢板内固定联合人工骨植骨(钢板人工骨组),23例采用锁定钢板内固定联合自体髂骨植骨(钢板自体骨组)。比较围手术期资料,采用肩关节功能Constant评分评定临床效果,拍摄肩关节正位X线片,测量肱骨颈干角,评估骨折复位丢失情况。[结果]三组患者均顺利手术,均未发生血管、神经损伤等严重并发症。钢板自体骨组手术时间最长,术中失血量最多,显著高于单纯钢板组和钢板人工骨组(P<0.05)。随访时间(20.77±6.80)个月。所有患者骨折均愈合,无再骨折。末次随访时Constant评分三组间差异无统计学意义(P>0.05)。影像测量方面,术后即刻和末次随访时三组间颈干角的差异无统计学意义(P>0.05);但是,各组两时间点间比较,三组患者颈干角均有丢失,其中,单纯钢板组丢失最明显,两时间点间颈干角的差异有统计学意义(P<0.05)。至末次随访时,单纯钢板组和钢板人工骨组各有1例患者表现出肱骨头坏死。[结论]虽然植骨可减轻术后颈干角丢失,对老年肱骨近端Neer三部分骨折采用单纯锁定钢板固定即可获得良好的效果。[Objective] To investigate the clinical outcomes of locking plate only versus plate combined with bone grafting for Neer 3-part proximal humeral fractures. [Methods] A retrospective study was conducted on 77 patients who underwent surgical treatment for 3-part proximal humeral fractures in our hospital from January 2011 to January 2017, including 26 males and 51 females aged(68.30±5.62) years on average. Based on operation performed, 24 patients had fractures fixed with locking plate only(the LPO group), 30 patients underwent fixation with locking plate combined with artificial bone implantation(the PAB group), and 23 patients received treatment with locking plate combined with bone autograft(the PBA group). The perioperative parameters, Constant scores, humeral neck-shaft angle measured radiographically were compared among the 3 groups.[Results] All the patients in the 3 groups had operation done smoothly without serious complications, such as neurovascular injuries. The PBA group had the longest operation time, and greatest intraoperative blood loss, which proved significantly greater than the OLP group and PAB group(P<0.05). The follow-up period lasted for(20.77±6.80) months on average. All the patients achieved bony healing without refracture in anyone of them. No statistically significant differences in Constant scores was noted among the 3 groups at the latest follow up(P>0.05). In term of radiographic assessment, no statistically significant differences in neck-shaft angle were noticed among the 3 groups immediately after operation and at 1 year postoperatively(P>0.05). However, losses of neck-shaft angle were noted in all the 3 groups compared the angles immediately after operation with those at 1 year postoperatively, which proved statistically significant in the LPO group(P<0.05), whereas not statistically significant in the PAB and PBA groups(P>0.05). To the latest follow up, 2 case of avascular necrosis of humeral head were found each one in the LPO group and the PAB group respectively. [Conclusions

关 键 词：Neer三部分肱骨近端骨折 锁定钢板 人工骨植骨术 自体髂骨植骨术 老年人 

分 类 号：R683.41[医药卫生—骨科学]