锁定钢板内固定联合不同骨移植修复老年肱骨近端Neer 3,4部分骨折  

Locking plate fixation combined with different bone grafts for Neer 3-and 4-part fractures of proximal humerus in the elderly

作　　者：刘文杰 余丽娟 徐彬[2] Liu Wenjie;Yu Lijuan;Xu Bin(Shanxi Medical University,Taiyuan 030001,Shanxi Province,China;Department of Orthopedics,The First Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学,山西省太原市030001 [2]山西医科大学第一医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2021年第30期4851-4856,共6页Chinese Journal of Tissue Engineering Research

基　　金：山西医科大学第一医院骨科的支持与帮助。

摘　　要：背景:老年肱骨近端Neer 3、4部分骨折患者近端骨质较差,骨折复位后骨缺损严重,单纯锁定钢板固定效果欠佳。目的:探讨锁定钢板联合同种异体髂骨和腓骨在老年肱骨近端Neer 3,4部分骨折中的应用效果和作用机制。方法:对在山西医科大学第一医院骨科2014年11月至2019年3月采用不同手术方法治疗的64例老年肱骨近端Neer 3,4部分骨折患者进行回顾性分析,其中单纯锁定钢板组(A组)24例,锁定钢板联合同种异体髂骨组(B组)19例,锁定钢板联合同种异体腓骨组(C组)21例。比较3组患者的疗效差异:(1)一般指标:手术时间、术中出血量、住院时间;(2)影像学指标:肱骨颈干角、肱骨头高度、骨折愈合时间;(3)疗效指标:肩关节Constant-Murley评分、目测类比评分、并发症发生率。结果与结论:(1)所有患者骨折均获愈合,随访时间12-24个月;(2)A组在手术时间和住院时间方面优于B、C组,差异有显著性意义(P<0.05);但在术中出血量方面,与B组和C组相比差异无显著性意义(P>0.05);B组和C组的上述3项指标比较差异均无显著性意义(P>0.05);(3)A组的肱骨颈干角和肱骨头高度变化大于B、C组(P<0.05),其中B组和C组相比差异无显著性意义(P>0.05);在愈合时间方面,3组两两比较差异均有显著性意义(P<0.05),其中A组>C组>B组;(4)A组Constant-Murley评分总分及主动活动项目得分低于B、C组(P<0.05),其中B组和C组相比差异无显著性意义(P>0.05);3组在目测类比评分方面比较差异无显著性意义(P>0.05);(5)并发症:A组术后出现螺钉切出1例,肱骨头坏死1例,关节僵硬2例;B组出现肩峰撞击综合征1例;C组出现螺钉切出1例,肱骨头坏死1例;3组并发症发生率相比差异无显著性意义(P>0.05);(6)提示老年肱骨近端Neer 3,4部分骨折的治疗首选锁定钢板;对于骨缺损较大者,可选择联合同种异体腓骨以实现机械稳定过渡;对于部分骨缺损者,可联合同种异体髂�BACKGROUND:Elderly patients with Neer 3-and 4-part fractures of the proximal humerus have poor proximal bone,so the bone defect after fracture reduction is very serious,which will lead to poor effect of simple locking plate fixation.OBJECTIVE:To evaluate the efficacy and mechanism of allogeneic ilium and fibula in the treatment of Neer 3-and 4-part fractures of the proximal humerus in the elderly.METHODS:Data of 64 elderly patients with Neer 3-and 4-part fractures of the proximal humerus and undergoing different surgery techniques in Department of Orthopedics,The First Affiliated Hospital of Shanxi Medical University from November 2014 to March 2019 were retrospectively analyzed.They were divided into three groups:single locking plate(group A,24 cases),locking plate combined with allogeneic ilium(group B,19 cases)and locking plate combined with allogeneic fibula(group C,21 cases).The following observation indexes were compared in three groups:(1)General indicators:operation time,intraoperative blood loss,hospital stay;(2)imaging indicators:the neck-shaft angle,humerus head height,and healing time;(3)efficacy indicators:Constant-Murley score,visual analog scale,the incidence of complications.RESULTS AND CONCLUSION:(1)All patients were healed and followed up from 12 to 24 months.(2)The operation time and hospital stay in group A were significantly better than those in groups B and C(P<0.05).However,there was no significant difference in intraoperative blood loss compared with groups B and C(P>0.05).There was no significant difference in three indicators between groups B and C(P>0.05).(3)Group A had higher neck-shaft angle and humerus head height than groups B and C(P<0.05),and there was no significant difference between group B and group C(P>0.05).There were significant differences in the healing time between groups A,B and C(P<0.05),in which group A>group C>group B.(4)The total Constant-Murley score and the score of active items in group A were lower than those in groups B and C(P<0.05),and there was no significan

关 键 词：肱骨近端骨折 锁定钢板 骨移植 髂骨 腓骨 植骨 骨折 内固定 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]