锁定钢板内固定联合髂骨植骨治疗老年肱骨近端粉碎性骨折的疗效  

Efficacy of locking plate internal fixation combined with iliac bone grafting in the treatment of comminuted proximal humeral fracture in the elderly

作　　者：李厚熹 梁承志 苏轶楣 刘国明 杜现法[2] 扈延龄[2] Li Houxi;Liang Chengzhi;Su Yimei;Liu Guoming;Du Xianfa;Hu Yanling(School of Clinical Medicine,Shandong First Medical University,Jinan 250000,China;Department of Trauma Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Dermatology,Qingdao Haici Medical Group,Qingdao 266033,China)

机构地区：[1]山东第一医科大学临床医学院,济南250000 [2]青岛大学附属医院创伤外科,青岛266000 [3]青岛市海慈医疗集团皮肤科,青岛266033

出　　处：《中华创伤杂志》2023年第3期238-244,共7页Chinese Journal of Trauma

摘　　要：目的比较锁定钢板内固定联合髂骨植骨与单纯锁定钢板内固定治疗老年肱骨近端粉碎性骨折的疗效。方法采用回顾性队列研究分析2018年1月至2020年1月青岛大学附属医院收治的42例老年肱骨近端粉碎性骨折患者的临床资料,其中男20例,女22例;年龄65~75岁[(69.5±8.5)岁]。骨折Neer分型:三部分骨折26例,四部分骨折16例。18例行锁定钢板内固定联合自体髂骨植骨(植骨组),24例行单纯锁定钢板内固定(非植骨组)。比较两组手术时间、术中出血量、术后引流量、住院时间、骨折愈合时间。比较两组术后1,6,12个月及末次随访时肩关节活动度(前屈、后伸、内旋和外旋)和肱骨头高度丢失程度。比较两组术前、术后1,6,12个月及末次随访时肩关节Neer评分和视觉模拟评分(VAS)。观察并发症发生情况。结果患者均获随访12~24个月[(18.5±3.8)个月]。两组手术时间、术中出血量、术后引流量及住院时间差异无统计学意义(P均>0.05)。植骨组骨折愈合时间为(3.1±0.7)个月,短于非植骨组的(4.2±0.9)个月(P<0.05)。随着术后时间延长,两组肩关节各项活动度及肱骨头高度丢失程度明显增加(P均<0.01)。术后1,6,12个月及末次随访时植骨组肩关节前屈为(136.2±7.4)°、(139.3±6.9)°、(146.6±6.1)°、(148.4±4.7)°,大于非植骨组的(134.5±6.7)°、(136.5±7.0)°、(137.9±9.2)°、(138.3±7.9)°;植骨组后伸为(37.1±6.3)°、(40.5±4.4)°、(43.1±3.1)°、(46.6±4.2)°,大于非植骨组的(35.5±4.6)°、(37.9±5.1)°、(41.3±2.5)°、(43.9±3.1)°;植骨组内旋为(50.5±3.2)°、(54.1±5.6)°、(56.6±4.2)°、(58.9±3.6)°,大于非植骨组的(46.9±5.1)°、(50.3±4.2)°、(53.5±2.7)°、(55.4±5.1)°;植骨组外旋为(52.2±3.6)°、(55.6±4.3)°、(58.7±4.4)°、(60.2±5.6)°,大于非植骨组的(50.1±4.7)°、(52.6±5.7)°、(55.3±3.2)°、(57.3±4.1)°(P<0.05或0.01)。术后1,6,12个月及末次随访时植骨组肱骨头高度丢�Objective To compare the efficacy between locking plate internal fixation combined with iliac bone graft and separate locking plate internal fixation in the treatment of comminuted proximal humeral fracture in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 42 elderly patients with comminuted proximal humeral fracture admitted to Affiliated Hospital of Qingdao University from January 2018 to January 2020.There were 20 males and 22 females,aged 65-75 years[(69.5±8.5)years].According to Neer classification,there were 26 patients with three-part fracture and 16 with four-part fracture.Eighteen patients were treated by locking plate internal fixation combined with autologous iliac bone grafting(bone grafting group),and 24 patients were treated by locking plate internal fixation alone(non-bone grafting group).The operation time,intraoperative blood loss,postoperative drainage volume,hospitalization time,and fracture healing time were documented.Shoulder joint range of motion(forward flexion,extension,internal rotation and external rotation)and degree of humeral head height loss were measured at 1,6,12 months after operation and at the last follow-up.The Neer score and visual analogue score(VAS)of shoulder joint were evaluated at 12 months after operation and at the last follow-up.The complications were observed.Results All patients were followed up for 12-24 months[(18.5±3.8)months].There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume and hospitalization time between the two groups(all P>0.05).The fracture healing time in bone grafting group was(3.1±0.7)months,shorter than(4.2±0.9)months in non-bone grafting group(P<0.05).In the two groups,the postoperative shoulder joint range of motion and degree of humeral head height loss increased significantly over time(all P<0.05).At 1,6,12 months after operation and at the last follow-up,the shoulder forward flexion range of motion in bone grafting group was(136.2±7.4

关 键 词：肱骨骨折 骨折固定术 内 老年人 

分 类 号：R687.3[医药卫生—骨科学]