内侧柱支撑重建结合锁定钢板内固定在不同类型老年肱骨近端骨折中的临床疗效  

Clinical effect of medial column support reconstruction combined with locking plate internal fixation in different types of elderly proximal humerus fractures

作　　者：夏丽平 杨德福 XIA Li-ping;YANG De-fu(Department of Orthopedics,The Dafeng Tongren Hospital,Yanchen,Jiangsu,China,224100)

机构地区：[1]盐城大丰同仁医院,江苏盐城224100

出　　处：《中国伤残医学》2019年第22期5-8,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:分析内侧柱支撑重建结合锁骨钢板内固定在不同类型老年肱骨近端骨折的临床疗效.方法:回顾性分析2012年11月-2018年8月间行内侧柱支撑重建结合锁定钢板内固定治疗的38例老年肱骨近端骨折患者.根据Neer分型将其分为3组,分别是:2部分骨折12例;3部分骨折20例;4部分骨折6例.比较不同组间术后末次随访时肱骨头干角、肱骨头高度丢失值及Constant-Mudey肩关节功能评分.结果:所有患者均获得随访,随访时间9-24个月(平均21个月),38例患者均骨性愈合,骨折愈合时间约为3-8(5.4±0.6)个月.末次随访时4部分骨折组头干角及肩关节功能Constant-Mudey评分均明显低于2、3部分骨折组,差异均有统计学意义,其中头干角分别是121° ±4°、129° ±4°、127° ±3°,肩关节功能Constant-Mudey评分分别是(66±3.9)分、(85±4.2)分、(81±4.7)分;但肱骨头高度丢失值差异无明显统计学意义,分别是(1.9±0.5)mm、(1.6±0.4)mm、(1.7±0.5)mm.7例患者出现术后并发症,发生率18.4%.4部分骨折有2例患者,发生率为33.3%,明显高于2部分骨折(1例)8.3%,3部分骨折(4例)20.0%.结论:内侧支撑理念结合锁定钢板固定在2、3部分老年肱骨近端骨折中疗效可靠.针对4部分骨折,在慎重选择病例的基础上,内侧柱支撑重建结合锁定钢板亦能获得较好的临床疗效.Objective:To analyze the clinical efficacy of medial column support reconstruction combined with locking plate internal fixation in different types of elderly proximal humeral fractures.Methods:A retrospective analysis was made on 38 elderly patients with proximal humeral fractures who underwent medial column support reconstruction with locking plate internal fixation from November 2012 to August 2018.According to the Neer classification,all the patients were divided into three groups:12 cases with two-part fractures,20 cases with three-part fractures,and 6 cases with four-part fractures.The humerus neck angle,humeral head height loss and Constant-Mudey shoulder function score were compared between the different groups at the last follow-up.Results:All patients were followed up for 9-24 months(mean 21 months).All 38 patients had bone healing and the fracture healing time was about 3-8(5.40.6)months.At the last follow-up,the Constant-Mudey scores of shoulder function and the humerus neck angle in the 4-part fracture group were significantly lower than those in the 2 and 3-part fracture groups,with the humerus neck angles being(1214)degrees,(1294)degreess,(1273)degrees respectively,while the Constant-Mudey scores being(663.9)points,(854.2)points,and(814.7)points,respectively;however,there was no statistically significant difference in the height loss of the humeral heads,which was(1.90.5)mm.,(1.60.4)mm,(1.70.5)mm.Postoperative complications occurred in 7 patients,with an total incidence of 18.4%.There were 2 patients with 4-part fractures,the incidence rate was 33.3%,which was significantly higher than 2-part fractures(1 case)8.3%,and 3-part fractures(4 cases)20.0%.Conclusion:The medial column support concept combined with locking plate fixation was effective in 2 and 3 part of the elderly proximal humeral fractures.For the 4-part fracture,on the basis of carefully selected cases,the medial column support reconstruction combined with the locking plate could also obtain a satisfied clinical outcome.

关 键 词：肱骨近端骨折 锁定钢板内固定 内侧柱支撑重建 

分 类 号：R683.41[医药卫生—骨科学]