锁定钢板结合髓内钛网支撑治疗老年肱骨近端骨折的疗效分析  

Treatment of the aged patients with unstable proximal humeral fracture with a locking plate and an intramedullary titanium mesh

作　　者：陈辉[1] 芮云峰[1] 崔学良 李贺[1] 石柳[1] 吴旋[1] 范文斌 高君义 Chen Hui;Rui Yunfeng;Cui Xueliang;Li He;Shi Liu;Wu Xuan;Fan Wenbin;Gao Junyi(Department of Orthopedics,Zhongda Hospital Affiliated to Southeast University,Institute of Traumatic Orthopedics,Zhongda Hospital Affiliated to Southeast University,Trauma Center,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院骨科,东南大学附属中大医院创伤中心,东南大学创伤骨科研究所,南京210009

出　　处：《中华创伤骨科杂志》2023年第5期422-426,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨锁定钢板结合髓内钛网支撑治疗老年肱骨近端骨折的疗效。方法回顾性分析2017年1月至2019年7月东南大学附属中大医院骨科收治的43例老年肱骨近端骨折患者资料。男13例,女30例;年龄(71.3±10.3)岁,范围值为60~83岁。所有的患者均采取锁定钢板结合髓内钛网支撑治疗。术后的影像学评价指标包括肱骨头高度(HHH)和颈干角的改变值(术后3年与术后第2天的差值,取绝对值)。术后临床评价指标包括疼痛视觉模拟评分(VAS)、肩关节活动度、Constant-Murley肩关节功能评分(Constant评分)、美国肩肘外科协会评分(ASES)及并发症发生情况。结果所有患者术后获(39.2±2.3)个月随访。术后3年HHH的改变值为(1.5±1.1)mm,颈干角的改变值为3.3°±2.6°;术后3年VAS评分为(2.2±1.3)分,Constant评分为(79.2±9.1)分,ASES评分为(78.9±9.2)分,前伸活动范围为143.2°±20.8°,外展活动范围为139.3°±23.1°,外旋活动范围55.1°±4.7°。术后共6例患者出现并发症,其中2例肱骨头坏死,1例异位骨化,3例感染。结论对于老年肱骨近端骨折,采用锁定钢板结合髓内钛网治疗,可协助建立内侧柱支撑并取得较好的治疗效果。Objective To evaluate the radiological and clinical outcomes of the aged patients with unstable proximal humeral fracture(UPHF)treated with a locking plate and an intramedullary titanium mesh.Methods A retrospective study was conducted to analyze the 43 aged patients with UPHF who had been admitted to Department of Orthopedics,Zhongda Hospital Affiliated to Southeast University from January 2017 to July 2019.There were 13 males and 30 females with an age of(71.3±10.3)years(from 60 to 83 years).All patients were treated with a locking plate and an intramedullary titanium mesh to support.The postoperative imaging measurements included changes in humeral head height(HHH)and neck-shaft angle(NSA)(the difference between 3 years after surgery and the second day after surgery,taken as an absolute value);the postoperative clinical measurements included visual analogue scale(VAS),range of shoulder motion,Constant-Murley shoulder functional score(Constant score),American Shoulder and Elbow Surgeons(ASES)score,and incidence of complications.Results All patients were followed up for(39.2±2.3)months after surgery.The change in HHH at 3 years after surgery was(1.5±1.1)mm,and the change in NSA at 3 years after surgery 3.3°±2.6°.At 3 years after surgery,the VAS score was(2.2±1.3)points,the Constant score(79.2±9.1)points,and the ASES score(78.9±9.2)points;the range of forward extension was 143.2°±20.8°,the range of outward extension 139.3°±23.1°,and the range of outward rotation 55.1°±4.7°.Complications after surgery were found in 6 patients,including humeral head necrosis in 2 cases,ectopic ossification in 1 case,and infection in 3 cases.Conclusion In the treatment of the aged patients with UPHF,a locking plate combined with an intramedullary titanium mesh can help to restore the medial column support,leading to fine radiological and clinical outcomes.

关 键 词：肩关节 老年人 骨折固定术 内 肱骨近端骨折 锁定钢板 钛网 

分 类 号：R687.3[医药卫生—骨科学]