两种手术方法治疗NeerⅢ型肱骨近端骨折的临床研究  

Clinical study of two surgical methods for the treatment of Neer typeⅢproximal humeral fractures

作　　者：程邦君[1] 黄燕峰[1] 罗轶[1] 何耀华[1] Cheng Bangjun;Huang Yanfeng;Luo Yi;He Yaohua(Department of Orthopedics,Jinshan Branch of Shanghai Sixth People’s Hospital,Shanghai 201599,China)

机构地区：[1]上海市第六人民医院金山分院骨科,201599

出　　处：《中华肩肘外科电子杂志》2021年第4期335-340,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：上海市卫生健康委员会科研课题(2020-190);上海市重点学科科研课题(ZK2019B03);上海健康医学院运动医学临床研究中心科研课题(20MC2020003)。

摘　　要：目的观察比较采用单纯外侧PHILOS钢板和外侧PHILOS钢板结合内侧支撑钢板治疗NeerⅢ型肱骨近端骨折的临床疗效。方法2015年1月至2020年1月本科室收治的NeerⅢ型肱骨近端骨折患者65例,其中32例采用单纯外侧PHILOS钢板治疗(单钢板组),另33例采用PHILOS钢板结合内侧支撑钢板治疗(双钢板组)。对比两组的手术时间、术中出血量、骨折愈合时间、术后第12个月肱骨颈干角、术后6个月和12个月的Neer评分及Constant评分等相关指标。结果两组患者术中均无神经血管损伤情况发生,伤口均Ⅰ期愈合。所有患者均获得随访12个月。双钢板组在手术时间、术中出血量、骨折愈合时间明显大于单钢板组(P<0.01)。双钢板组在术后第6个月和第12个月Neer评分和Constant肩关节评分系统的评分明显高于单钢板组(P<0.01)。在术后第12个月末次随访时,双钢板组的肱骨颈干角较单钢板组更加接近正常值(P<0.01)。结论对于NeerⅢ型肱骨近端骨折合并内侧柱损伤的患者来说,采用外侧PHILOS钢板结合内侧支撑钢板治疗,可以提高肱骨近端内侧稳定性及肱骨近端整体牢固性,降低术后骨折复位丢失、肱骨头内翻、内固定失效等并发症的发生率,可以早日行肩关节康复功能锻炼,恢复肩关节功能。Background With the continuous progress of domestic aging,the occurrence of proximal humeral fractures is second only to distal radius fractures and hip fractures,ranking third with an incidence of approximately 4%-5%.The first choice for the treatment of patients with Neer typeⅢorⅣproximal humeral fractures is the locking plate technique.With the increasing number of proximal humerus fractures in recent years,the postoperative complications of locking plate technique alone have been increasingly concerned.Relevant studies in recent years have found that the poor quality of proximal humerus and the loss of medial column are the main reasons for postoperative complications.In this study,a buttress plate was placed on the inner side of the proximal humerus to enhance the overall stability and firmness of proximal humerus and reduce postoperative complications.Objective To observe and compare the clinical efficacy of the simple lateral PHILOS plate and the lateral PHILOS plate combined with the medial buttress plate in the treatment of Neer typeⅢproximal humeral fractures.Methods From January 2015 to January 2020,65 patients with Neer typeⅢproximal humeral fractures were admitted into our department.Among them,32 cases were treated with lateral PHILOS plate,and the other 33 cases were treated with PHILOS plate combined with medial buttress plate.The operation time,intraoperative blood loss,fracture healing time,humeral neck shaft angle in the 12th month after operation,Neer score and Constant score in the 6th and 12th months after operation were compared between the two groups.Results No neurovascular injury occurred in the two groups of patients during the operation,and the wounds healed at first stage.All patients were followed up for 12 months.The operation time,intraoperative blood loss,and fracture healing time of the double-plate group were significantly longer than those of the single-plate group(P<0.01).The Neer score and Constant score of the double-plate group in the 6th and 12th months after surge

关 键 词：肱骨近端骨折 NeerⅢ型 PHILOS钢板 支撑钢板 

分 类 号：R687.3[医药卫生—骨科学]