内侧柱有效支撑对内翻型肱骨近端骨折疗效的影响  

Effect of the effective support of the medial column on the postoperative fracture of the proximal humerus with varus

作　　者：韩庆辉[1] 王暑光 唐小莹 孙贵新[1] Han Qinghui;Wang Shuguang;Tang Xiaoying;Sun Guixin(Department of Orthopedics,East Hospital of Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院创伤骨科,上海200120

出　　处：《创伤外科杂志》2021年第5期326-331,共6页Journal of Traumatic Surgery

基　　金：上海市浦东新区科委课题(2017PKJ-Y20)。

摘　　要：目的分析内侧柱有效支撑对内翻型肱骨近端骨折疗效的影响。方法回顾性分析2013年5月—2018年7月同济大学附属东方医院创伤骨科采用肱骨近端内锁定系统(PHILOS)锁定钢板治疗内翻型肱骨近端骨折患者49例,男性19例,女性30例;年龄25~86岁,平均57.1岁。摔伤11例,道路交通伤13例,坠落伤10例,运动伤8例,其他伤7例。伤后手术时间1~10d,平均4.3d。根据Neer分型:二部分骨折21例,三部分骨折17例,四部分骨折11例;其中合并脱位7例。根据患者术后X线片示肱骨近端内侧柱支撑情况分为内侧柱支撑组(26例)和无内侧柱支撑组(23例)。所有患者门诊随访,随访时间13~49个月,平均15.3个月。比较两组患者术后第12个月肱骨头内翻角的变化、肩关节Constant评分及并发症[肱骨头内翻(末次随访与术后内翻角之差超过5°)、螺钉切出关节面、内固定失效及肱骨头坏死]发生率,分析内侧柱支撑对骨折复位的维持和肩关节功能的影响。结果两组患者骨折愈合时间8~24周,平均13.6周。术后第12个月(末次随访)时两组患者肱骨头内翻角分别平均(1.2±0.8)°和(8.4±2.9)°,肩关节Constant评分平均(85.3±10.9)分和(68.3±8.7)分,并发症发生率7.7%(2/26)和43.5%(10/23),差异均有统计学意义(P<0.05)。结论内侧柱支撑可提高内翻型肱骨近端骨折内侧柱机械稳定性,更好地维持复位,提高手术疗效并降低相关并发症发生率。Objective To analyze the effect of effective medial column support on plate internal fixation for varus proximal humeral fractures.Methods A total of 49 patients with varus proximal humeral fracture were treated with proximal humerus internal locking system(PHILOS)from May 2013 to Jul.2018.There were 19 males and 30 females,with an average age of 57.1years(25-86 years).There were 11 cases of falling injuries,13 cases of road traffic injuries,10 cases of high-falling injuries,8 cases of sports injuries,and 7 cases of other injuries.The time from operation after injury was 1-10 days,with an average of 4.3 days.According to Neer classification:there were 21 cases of two parts fracture,17 cases of three parts fracture and 11 cases of four parts fracture.There were 26 cases in the medial column support group and 23 cases in the non-medial column support group.All patients were followed up from 13 to 49 months in the outpatient department(mean 15.3 months).The change of humeral head varus angle,shoulder function Constant-Murley score and complication rate were compared between the two groups at the 12th month after operation.The effect of effective support of medial column on fracture reduction and shoulder function was analyzed.Results The average healing time of the two groups was 13.6 weeks(8-24 weeks).At twelfth month after operation,the average humeral head varus angle was(1.2±0.8)°and(8.4±2.9)°,the average Constant-Murley score of shoulder joint was(85.3±10.9)points and(68.3±8.7)points,the incidence of complications was 7.7%(2/26)and 43.5%(10/23)respectively and the differences were statistically significant(P<0.05).Conclusion The medial column support can improve the mechanical stability of the medial column,maintain the reduction better,improve the postoperative effect and reduce the related complications.

关 键 词：肱骨近端骨折 内翻型 锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]