肱骨近端锁定钢板结合外展架治疗肱骨近端骨折疗效观察  

Curative Effect of Locking Proximal Humeral Plate plus Abduction Frame on Proximal Humeral Fracture

作　　者：张晓艳[1] 王毅[1] 徐永清[1] Zhang Xiaoyan;Wang Yi;Xu Yongqing(PLA Research Institute of Trauma and Orthopedics,No.920 Hospital under Guilin Joint Logistic Support Center,Kunming,Yunnan Province,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队920医院全军创伤骨科研究所,云南昆明650032

出　　处：《西南军医》2020年第5期416-420,共5页Journal of Military Surgeon in Southwest China

基　　金：云南省卫健委临床中心建设重大项目(项目编号:2019-2022)。

摘　　要：目的探讨肱骨近端锁定钢板(Locking Proximal Humeral Plate,LPHP)结合外展架治疗肱骨近端骨折的临床疗效。方法回顾性分析2016年1月至2019年12月,我院收治的68例肱骨近端骨折患者资料。骨折按Neer分型:Ⅱ型21例,Ⅲ型43例,Ⅳ型4例。所有患者均使用肱骨近端锁定钢板内固定,术后次日使用外展架固定患肢外展80°~90°,上举90°~100°。指导患者在外展架上行低强度的功能锻炼,末次随访时评估患者Constant-Murley评分、患肩的活动度及相关并发症。结果66例患者于术后随访12~16个月钟,一期愈合良好,未发生术口感染、钢板断裂、松动及骨折再移位。并发症发生率2.9%,有肱骨头缺血坏死2例。末次随访时Constant-Murley评分平均93.2分,优良率为95.6%。患肩活动度平均分别为:前屈上举161.2°,外展153.4°,外旋56.8°,内旋65.3°。结论锁定钢板内固定术治疗肱骨近端骨折固定牢固,有利于保护骨折处血供,减少并发症,加速骨折愈合,术后结合外展架外固定利于早期功能锻炼及功能恢复,避免了术后肩关节粘连、僵硬导致的功能障碍。ObjectiveTo investigate the clinical curative effect of locking proximal humoral plate(LPHP)plus abduction frame on proximal humeral fracture.Methods The clinical data of 68 cases(16 male and 52 female,aged from 28 to 45 years old with an average age of 39.15±1.62)with proximal humeral fracture during the period from January 2016 to December 2019 were retrospectively analyzed;based on Neer classification,there were 21 cases with the fracture of typeⅡ,43 of typeⅢand 4 of typeⅣ;internal fixation with LPHP was performed on all the cases and then,on the second day,abduction frame was used to limit the limb abduction from 80°to 90°and limb elevation from 90°to 100°;all cases were instructed to do low-intensity functional exercises with abduction frame;evaluation of the Constant-Murley scores,shoulder mobility and related complications was made at the last follow-up.Results The follow-up of 68 cases lasting from 12 to 16 months after surgery showed good one-stage healing and no surgical site infection(SSI),internal steel plate breakage,internal steel plate loosening or fracture displacement occurred;the occurrence of complications was 2.9%and necrosis in humeral heads was found in 2 cases;the average Constant-Murley score at the last follow-up was 93.2%and the excellent and good rate was 95.6%;the average degrees of shoulder movement were:anterior flexural uplift:161.2°,abduction:153.4°,external rotation:56.8°and internal rotation:65.3°.Conclusions LPHP fixation for proximal humeral fracture can provide a firm fixation,protect the blood supply at fracture site,reduce the occurrence of complications and fasten the healing of fracture,and the fixation with abduction frame after surgery is good for early functional exercises and function recovery so as to avoid the dysfunction caused by post-operative shoulder joint adhesion and rigidity.

关 键 词：肱骨近端骨折 锁定钢板 外展架 

分 类 号：R683[医药卫生—骨科学]