锁定钢板结合自体大块髂骨治疗老年复杂肱骨近端骨折的疗效  

Efficacy of locking plate combined with large autologous ilium crest graft for complex proximal humeral fractures in elderly patients

作　　者：游小军 路考生 韩月起 宋向青 李杰 曲巧格 You Xiaojun;Lu Kaosheng;Han Yueqi;Song Xiangqing;Li Jie;Qu Qiaoge(Orthopedics Department No.11,General Hospital of Jizhong Energy Xingtai Mining Group,Xingtai 054000,China)

机构地区：[1]冀中能源邢台矿业集团总医院骨十一科,邢台054000

出　　处：《中华创伤杂志》2020年第3期222-227,共6页Chinese Journal of Trauma

摘　　要：目的探讨锁定钢板结合植入自体大块髂骨与单纯锁定钢板治疗老年肱骨近端粉碎性、骨质缺损的复杂肱骨近端骨折的临床疗效。方法采用回顾性病例对照研究分析2014年1月—2017年3月冀中能源邢台矿业集团总医院收治的52例老年单侧肱骨近端骨折伴粉碎性、骨质缺损患者临床资料,其中男24例,女28例;年龄65~79岁,平均69岁。Neer三部分骨折36例,四部分骨折16例。采用锁定钢板结合大块自体髂骨植骨治疗22例(钢板+植骨组),单纯采用锁定钢板治疗30例(钢板组)。两组均采用三角肌-胸大肌入路。比较两组手术时间、术中出血量、骨折愈合时间、末次随访颈干角、肩关节活动度(前屈上举、外展、外旋、后伸),末次随访时采用36项健康调查简表(SF-36)评分、视觉模拟评分(VAS)评价肩关节功能和疼痛情况,观察并发症情况。结果52例患者均获随访6~24个月,平均17.8个月。钢板+植骨组手术时间为(120.3±12.5)min,钢板组为(115.6±5.8)min(P<0.01)。钢板+植骨组术中出血量为(400.8±15.8)ml,钢板组为(300.2±16.2)ml(P<0.05)。钢板+植骨组骨折愈合时间为(2.2±0.5)个月,钢板组为(2.5±0.5)个月(P>0.05)。末次随访时,钢板+植骨组颈干角为(132.3±10.6)°,钢板组为(121.1±4.5)°(P<0.01)。钢板+植骨组肩关节前屈上举[(149.2±3.7)°]、外旋[(35.2±2.9)°]均大于钢板组[(135.1±2.1)°、(27.8±4.5)°](P<0.05)。钢板+植骨组肩关节外展为(118.4±13.9)°,后伸为(36.1±1.8)°;钢板组分别为(110.8±21.9)°、(32.8±1.3)°(P>0.05)。钢板+植骨组SF-36评分[(87.3±4.7)分]较钢板组[(70.9±7.2)分]显著提高,VAS[(1.3±0.6)分]较钢板组[(2.1±0.7)分]显著降低(P<0.05或0.01)。钢板组术后1年3例出现肱骨头内翻,1例出现肱骨头部分坏死,并发症发生率为13%(4/30);钢板+植骨组,术后1年1例出现肱骨大结节吸收,并发症发生率为5%(1/22)(P<0.05)。结论对于粉碎性、骨质缺损的老年复杂肱�Objective To investigate the clinical effect of locking plate combined with large autologous iliac bone implantation in treatment of complex proximal humeral fractures with comminuted proximal humerus and bone defect.Methods A retrospective case-control study was conducted to analyze the clinical data of 52 elderly patients with proximal humeral fracture accompanied by comminuted and bone defect admitted to General Hospital of Jizhong Energy Xingtai Mining Group from January 2014 to March 2017.including 24 males and 28 females,aged 65-79 years,with an average age of 69 years.There were 36 patients with Neer's three part fracture and 16 four part fracture.Twenty-two patients were treated using locking plate combined with large autologous iliac bone graft(plate+bone graft group),and 30 patients were treated using locking plate alone(plate group).The deltoid-pectoralis major approach was used in both groups.Operation time,bleeding volume and bone healing time were recorded.neck trunk angle and shoulder joint range of motion were measured at the last follow up.MOS 36 item short form health survey(SF 36)score and visual analog scale(VAS)score were used to evaluate shoulder joint function and pain at last follow-up.Complications were observed as well.Results All patients were followed up for 6-24 months,with an average of 17.8 months.Operation time was(120.3±12.5)minutes in plate+bone graft group,and(115.6±5.8)minutes in plate group(P<0.01).Intraoperative bleeding volume was(400.8±15.8)ml in plate+bone graft group and(300.2±16.2)ml in plate group(P<0.05).Bone healing time was(2.2±0.5)months in plate+bone graft group and(2.5±0.5)months in plate group(P>0.05).At last follow-up,the neck-trunk angle was(132.3±10.6)°in plate+bone graft group and(121.1±4.5)°in plate group(P<0.01);the uplift and external rotation of shoulder joint was(149.2±3.7)°and(35.2±2.9)°in plate+bone group,better than that in plate group[(135.1±2.1)°,(27.8±4.5)°](P<0.05).Meanwhile,the abduction and extension of shoulder joint was(118.4

关 键 词：肩骨折 髂骨 内固定器 骨移植 

分 类 号：R687.3[医药卫生—骨科学]