NeerⅥ型肱骨近端骨折脱位的新分型及临床应用  

A novel subtyping of Neer typeⅥproximal humerus fracture-dislocation and its clinical application

作　　者：高化[1] 刘振宇[1] 白晓冬[1] 陈文韬[1] 王刚[1] 许国强 王逸骏 王稼田 马骥 宋大卫 陈坤 王宝军[1] Gao Hua;Liu Zhenyu;Bai Xiaodong;Chen Wentao;Wang Gang;Xu Guoqiang;Wang Yijun;Wang Jiatian;Ma Ji;Song Dawei;Chen Kun;Wang Baojun(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《中华创伤骨科杂志》2024年第8期657-663,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京市医院管理局培育项目(PX2021004);首都医学发展研究基金(2022-2-2027);国家自然科学基金(2022-2-2027)。

摘　　要：目的提出NeerⅥ型肱骨近端骨折脱位的细化新分型,探讨其临床应用价值。方法回顾性分析2018年1月至2022年12月期间首都医科大学附属北京友谊医院骨科收治的36例接受肱骨近端锁定内固定系统(PHILOS)手术治疗的NeerⅥ型肱骨近端骨折脱位患者资料。男25例,女11例;年龄(46.1±4.7)岁。根据骨折脱位情况及肱骨头干分离情况,将NeerⅥ型肱骨近端骨折脱位患者再细化为3个亚型(称为STAB分型):T型组(肩关节脱位伴大结节骨折,n=14),A型组(肱骨近端骨折脱位,但肱骨头与肱骨干不分离,n=12)和B型组(肱骨近端骨折脱位伴肱骨头与肱骨干分离,n=10)。由4位不同资历的医生分别在入院时、2周后对所有患者同样的影像资料进行STAB分型。验证该新分型的观察者间和观察者内部一致性。记录3个分型组患者的手术时间、骨折愈合时间、末次随访时疼痛视觉模拟评分(VAS)、Constant-Murley评分和并发症发生情况。结果3组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获(11.2±4.2)个月随访。STAB分型的观察者间和观察者内部Kappa值分别为0.94和0.95。T型组、A型组、B型组手术时间分别为(68.9±5.6)、(90.0±5.2)、(113.0±9.2)min,骨折愈合时间分别为(9.0±0.8)、(10.3±1.2)、(11.8±0.9)周,末次随访时VAS评分分别为1.0(1.0,2.0)、2.0(1.0,2.0)、2.0(2.0,3.0)分,Constant-Murley评分分别为(83.6±2.8)、(74.5±3.0)、(62.7±5.5)分。以上项目3组之间比较差异均有统计学意义(P<0.05)。总体闭合复位成功率为61.1%(22/36),T型组、A型组、B型组闭合复位成功患者数分别为13、7、2例,发生并发症患者数分别为2、3、6例,以上项目3组间比较差异均有统计学意义(P<0.05)。结论本研究提出的STAB分型组内和组间一致性强。尽管均为NeerⅥ型肱骨近端骨折脱位,但经STAB分型细化后显示出不同的效果差异,STAB分型或许可以为临床ObjectiveTo propose a novel refined subtyping of Neer typeⅥproximal humerus fracture-dislocation and explore its clinical application.MethodsA retrospective study was conducted to analyze the data of 36 patients who had been admitted to Department of Orthopaedics,Beijing Friendship Hospital between January 2018 and December 2022 for surgical treatment with proximal humeral internal locking system(PHILOS)for Neer typeⅥproximal humerus fracture-dislocation.There were 25 males and 11 females with an age of(46.1±4.7)years.According to the fracture-dislocation and the separation between the humeral head and the stem,the patients with Neer typeⅥproximal humerus fracture-dislocation were further subdivided into 3 subtype groups(known as STAB subtypes):subtype-T group(dislocation of the shoulder joint with macro-capitellar fracture,n=14),subtype-A group(proximal humerus fracture-dislocation without separation of the humeral head from the humeral stem,n=12),and subtype-B group(dislocation of the proximal humerus fracture with separation of the humeral head from the humeral stem,n=10).STAB subtyping was performed on the same imaging data from all the patients at admission and 2 weeks later by 4 surgeons with different qualifications.Interobserver and intraobserver agreements of the STAB typing were verified.The operation time,fracture healing time,visual analogue scale(VAS)pain score,Constant-Murley score,and complications were recorded for patients in the 3 subtype groups.ResultsThe differences in the preoperative general data were not statistically significant between the 3 subtype groups,indicating comparability(P>0.05).All patients were followed up for(11.2±4.2)months.The inter-observer and intra-observer Kappa values for STAB subtyping were 0.94 and 0.95,respectively.For subtype-T group,subtype-A group,and subtype-B group,respectively,the operation time was(68.9±5.6)min,(90.0±5.2)min,and(113.0±9.2)min;the fracture healing time was(9.0±0.8)weeks,(10.3±1.2)weeks,and(11.8±0.9)weeks;the VAS scores at the las

关 键 词：肩关节 骨折固定术 内 脱位 肱骨近端骨折 新分型 

分 类 号：R683.42[医药卫生—骨科学]