“三位一体”骨修复策略治疗老年骨质疏松性肱骨近端骨折的临床疗效  

Efficacy of“three-in-one”bone repair strategy for osteoporotic proximal humeral fractures in elderly patients

作　　者：吴银生 尤炯鸣 王勇 陈晓[2] 盛世豪 张涛[2] 张磊 WU Yinsheng;YOU Jiongming;WANG Yong;CHEN Xiao;SHENG Shihao;ZHANG Tao;ZHANG Lei(Department of Orthopaedics,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou 325000,Zhejiang,China;Department of Orthopaedics,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Orthopaedics,No.906 Hospital of Joint Logistics Support Force of PLA,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州市中西医结合医院骨科,温州325000 [2]海军军医大学(第二军医大学)第一附属医院骨科,上海200433 [3]中国人民解放军联勤保障部队第九〇六医院骨科,温州325000

出　　处：《海军军医大学学报》2024年第2期239-244,共6页Academic Journal of Naval Medical University

摘　　要：目的探讨采用“三位一体”骨修复策略治疗老年骨质疏松性肱骨近端骨折的临床疗效。方法采用回顾性病例研究,分析2019年4月―2020年5月温州市中西医结合医院收治的28例采用“三位一体”骨修复策略治疗的老年骨质疏松性肱骨近端骨折患者的临床资料。记录患者的骨折愈合时间、颈干角变化。末次随访时采用美国加利福尼亚大学洛杉矶分校(UCLA)肩关节评分评价肩关节功能,记录双侧关节活动度和并发症情况。结果28例患者中男8例、女20例,年龄为65~86(71.7±6.0)岁;二部分骨折10例,三部分骨折14例,四部分骨折4例;随访时间9~12个月,平均10.5个月。28例患者随访期间均获得骨性愈合,平均愈合时间为(12.6±1.5)周,平均颈干角为(133.1±5.6)°。平均UCLA评分为(31.1±4.1)分。患侧肩关节平均前屈上举、外展、外旋角度分别为(132.5±7.7)°、(116.5±7.0)°、(40.3±3.5)°,内旋至L_(2/3),与健侧[(169.5±7.3)°、(157.5±6.9)°、(52.1±4.2)°,内旋至T11/12]相比,差异有统计学意义(P<0.05)。28例患者中1例出现螺钉穿出,并发症发生率为3.6%。结论采用“三位一体”骨修复策略治疗老年骨质疏松性肱骨近端骨折的骨折愈合率高、手术并发症少、肩关节功能恢复好,临床疗效满意。Objective To investigate the clinical effect of“three-in-one”bone repair strategy in the treatment of osteoporotic proximal humeral fractures in elderly patients.Methods A retrospective case-control study was conducted to analyze the clinical data of 28 elderly osteoporotic patients with proximal humeral fractures treated with“three-in-one”bone repair strategy in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from Apr.2019 to May 2020.The fracture healing time and neck-trunk angle were recorded.At the last follow-up,shoulder function was evaluated by the University of California Los Angeles(UCLA)shoulder score,bilateral range of motion and complications were observed as well.Results There were 8 males and 20 females,aged 65-86(71.7±6.0)years.There were 10 patients with Neer’s two-part fracture,14 three-part fracture,and 4 four-part fracture.All patients were followed up for 9-12 months,with an average of 10.5 months.Bone union was achieved in 28 patients with a mean healing time of(12.6±1.5)weeks and a mean cervix-trunk angle of(133.1±5.6)°.The average UCLA shoulder score was(31.1±4.1).The mean uplift,abduction,and external rotation angles of the injured side shoulder joint were(132.5±7.7)°,(116.5±7.0)°,and(40.3±3.5)°,and the internal rotation reached L_(2/3).The mean uplift,abduction,and external rotation angles of the healthy side shoulder joint were(169.5±7.3)°,(157.5±6.9)°,and(52.1±4.2)°,and the internal rotation reached T11/12.The difference of range of motion between the 2 sides was statistically significant(P<0.05).Screw cut-out occurred in 1 patient,with a complication rate of 3.6%.Conclusion For the elderly patients with osteoporotic proximal humeral fracture,“three-in-one”bone repair strategy shows high bone union rate,low surgical complication rate,good recovery of shoulder joint function,and satisfied clinical results.

关 键 词：肩骨折 骨质疏松性骨折 内固定器 三位一体 

分 类 号：R687.3[医药卫生—骨科学]