反向穿针外固定术治疗高危老年肱骨近端骨折的血液系统评估及近期临床效果  

Hematologic evaluation and short-term clinical effect of reverse needle fixation in high-risk elderly patients with proximal humeral fractures

作　　者：杨名帅 田雅峰 张毅立 薛鹏宇 陈宝生 樊金瑞 杨易朋 周海 YANG Mingshuai;TIAN Yafeng;ZHANG Yili;XUE Pengyu;CHEN Baosheng;FAN Jinrui;YANG Yipeng;ZHOU Hai(The First Department of Orthopedics,Hebei Hospital of Traditional Chinese Medicine the First Affiliated Hospital of Hebei University of Chinese Medicine,Hebei Province,Shijiazhuang 050000,China;Graduate School,Hebei University of Chinese Medicine,Hebei Province,Shijiazhuang 050011,China)

机构地区：[1]河北省中医院河北中医学院第一附属医院骨伤一科,河北石家庄050000 [2]河北中医学院研究生学院,河北石家庄050011

出　　处：《中国医药导报》2023年第12期103-106,119,共5页China Medical Herald

基　　金：河北省中医药管理局科研计划项目(2020078)。

摘　　要：目的探讨反向穿针外固定术治疗高危老年肱骨近端骨折的血液系统评估及近期临床效果。方法回顾性分析2018年1月至2022年1月河北省中医院骨伤一科采用反向穿针外固定术治疗的28例高危老年肱骨近端骨折患者,收集患者手术时间、术中出血量、住院时间、外固定架拆除时间、并发症的相关资料。比较患者术前及术后7 d、3个月、6个月的红细胞计数、血红蛋白、红细胞压积的水平,采用Constant-Murley评分和肩部手术系统评分评价临床疗效,通过肩关节X线片观察骨折愈合程度。结果28例患者平均手术时间为(66.57±18.09)min,平均术中出血量为(12.02±2.52)ml,平均住院时间为(14.39±2.86)d,平均外固定拆除时间为(6.75±1.70)个月,均无明显并发症发生。患者术前及术后7 d、3个月、6个月的红细胞计数、血红蛋白、红细胞压积比较,差异无统计学意义(P>0.05)。患者术前及术后7 d、3个月、6个月的Constant-Murley评分总分及其中疼痛、日常活动、肩关节活动范围、肌力各项评分逐渐升高,差异有统计学意义(P<0.05)。患者术前及术后7 d、3个月、6个月的肩部手术评分系统评分逐渐降低,差异有统计学意义(P<0.05)。肩关节X线片检查显示骨折愈合良好。结论反向穿针外固定术治疗高危老年肱骨近端骨折血液系统评估稳定,术后近期临床效果满意,适合高危老年患者。Objective To investigate the hematologic evaluation and short-term clinical effect of reverse needle fixation in high-risk elderly patients with proximal humeral fractures.Methods The retrospective analysis was performed on 28 high-risk elderly patients with proximal humerus fracture treated by reverse needle puncture external fixation in the First Department of Orthopedics,Hebei Hospital of Traditional Chinese Medicine from January 2018 to January 2022.Data on operative time,intraoperative blood loss,length of stay,removal time of external fixator,and complications were collected.The levels of red blood cell count,hemoglobin,and hematocrit were compared before surgery and seven days,three months,six months after surgery.Constant-Murley score and shoulder surgery system score were used to evaluate the clinical efficacy.Shoulder joint X-ray image was used to observe the degree of fracture healing.Results The mean operation time of the 28 patients was(66.57±18.09)min,the mean intraoperative blood loss was(12.02±2.52)ml,the mean hospital stay was(14.39±2.86)d,and the mean removal time of external fixation was(6.75±1.70)months.No obvious complications occurred.There was no significant difference in the red blood cell count,hemoglobin,and hematocrit before surgery and at seven days,three months,six months after surgery(P>0.05).The total Constant-Murley score and scores of pain,daily activities,range of motion of shoulder joint,and muscle strength were increased gradually before surgery and at seven days,three months,six months after surgery,the differences were statistically significant(P<0.05).The scores of the shoulder surgery scoring system of patients before surgery and at seven days,three months,six months after surgery were gradually decreased,and the differences were statistically significant(P<0.05).X-ray images of the shoulder joint showed good healing.Conclusion The hematologic evaluation of the treatment of high-risk elderly patients with proximal humerus fracture by reverse needle fixation is stable,an

关 键 词：老年肱骨近端骨折 肩关节骨折 反向穿针外固定术 恒定评分 血液系统 

分 类 号：R683.4[医药卫生—骨科学]