切开复位内固定治疗移位的陈旧性肱骨大结节骨折  被引量:8

Open reduction and internal fixation for old displaced fractures of humeral greater tuberosity

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作  者:米萌[1] 张金明[2] 蒋协远[1] 黄强[1] Mi Meng;Zhang Jinming;Jiang Xieyuan;Huang Qiang(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,Beijing Mentougou District Hospital,Beijing 102300,China)

机构地区:[1]北京积水潭医院创伤骨科,100035 [2]北京市门头沟区医院骨科,102300

出  处:《中华创伤骨科杂志》2020年第11期944-948,共5页Chinese Journal of Orthopaedic Trauma

基  金:国家重点研发计划(2017YFB1304201)。

摘  要:目的探究治疗移位的陈旧性肱骨大结节骨折的手术技巧及相关因素。方法回顾性分析2010年11月至2019年3月北京积水潭医院创伤骨科手术治疗并完整随访的16例移位的陈旧性肱骨大结节骨折患者资料。男9例,女7例;平均年龄61岁(40~77岁)。12例原始损伤伴有肩关节脱位。原始移位的大结节骨折未及时手术治疗者8例,初次手术治疗大结节骨折未有效复位者4例,手术治疗后大结节骨折再次移位者4例。2例向前方移位,3例向后方移位,11例向上方移位。大结节移位距最后手术的平均时间为5个月。移位距离平均16.5 mm。记录并比较术前与术后6个月Constant-Murley评分和疼痛视觉模拟评分(VAS)。结果所有患者术后获平均55个月(16~118个月)随访。15例术后大结节解剖复位,顺利愈合;1例复位欠佳,随访发现大结节再次出现向上移位。16例患者术前与术后6个月Constant-Murley绝对值评分分别为(37.0±11.7)、(91.0±9.9)分,前屈上举范围分别为33.0°±26.7°、144.0°±38.5°,以上项目两组间比较差异均有统计学意义(P<0.05)。术前与术后6个月疼痛VAS评分分别为(4.5±1.0)、(0.7±1.3)分,术后VAS评分显著优于术前,差异有统计学意义(P<0.05)。术后有1例患者肩部功能评分欠佳,但尚能满意完成日常生活需要。结论移位的陈旧性肱骨大结节骨折,根据不同骨折移位特征,采用切开复位内固定手术治疗,可以获得满意疗效。Objective To investigate the operative treatments of old displaced fractures of humeral greater tuberosity and their related factors.Methods A retrospective study was conducted of the 16 patients who had received operative treatment at Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital for old displaced fractures of humeral greater tuberosity from November 2010 to March 2019 and whose complete follow-up data were available.They were 9 males and 7 females with an average age of 61 years(from 40 to 77 years).The original injury was accompanied by shoulder dislocation in 12 cases;the original displaced fracture of humeral greater tuberosity was not surgically treated in time in 8 cases;the primary surgical treatment did not lead to effective fracture reduction in 4 cases;the fracture of humeral greater tuberosity was displaced again after surgical treatment in 4 cases.Anterior displacement was observed in 2 cases,posterior displacement in 3 cases and superior displacement in 11 cases.The duration between the onset of displacement and the last operation averaged 5 months,and the displacement distance 16.5 mm.The Constant-Murley and visual analogue scale(VAS)scores were compared between preoperation and 6 months postoperation.Results This group of patients obtained a mean follow-up of 55 months(from 16 to 118 months).Anatomical reduction of the greater tuberosity was achieved in 15 cases,leading to uneventful union.Mal-reduction occurred in one patient whose greater tuberosity was found displaced superiorly again by follow-up.For the 16 patients,the Constant-Murley absolute value scores were 37.0±11.7 and 91.0±9.9,and the flexion elevation ranges 33.0°±26.7°and 144.0°±38.5°,respectively for preoperation and 6 months postoperation,showing significant improvements between preoperation and 6 months postoperation(P<0.05).The VAS scores were 0.7±1.3 at 6 months postoperation,significantly improved than the preoperative value 4.5±1.0(P<0.05).Postoperatively,good shoulder function scores were no

关 键 词:肩关节 脱位 骨折固定术  陈旧性骨折 肱骨大结节骨折 

分 类 号:R687.3[医药卫生—骨科学]

 

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