肱骨干骨折的两种内固定技术对肩关节功能影响的中长期研究  

Medium and long term research on the effects of two internal fixations on functions of shoulder joints in humeral shaft fracture

作　　者：栗剑[1] 张光武[1] 张昆[1] 吕鹏飞[1] 薛涛[1] 

机构地区：[1]北京大学首钢医院骨科,100144

出　　处：《中华肩肘外科电子杂志》2015年第3期160-163,共4页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：首都十大疾病科技成果推广脊柱关节退行性疾病治疗关键技术推广(Z131100002613002)

摘　　要：目的回顾性研究肱骨干骨折采用钢板内固定和顺行髓内钉固定后的肩关节症状、功能和运动范围。方法回顾性分析19例钢板和20例顺行髓内钉内固定对肩关节功能的影响。随访肩关节HSS、JOA、VAS评分,肩关节运动范围。钢板组平均随访7.3年(1~11年);髓内钉组平均随访6年(1~10年)。结果 HSS评分优良率:钢板组84.2%,髓内钉组65%;JOA评分优良率:钢板组78.9%,髓内钉组60%;VAS评分:钢板组1.78分,髓内钉组2.3分;肩关节运动范围:钢板组在前屈、外展、外旋运动方面优于髓内钉组。在肩关节评分、肩关节疼痛和运动范围方面,钢板组和髓内钉组间差异无统计学意义。结论两种内固定技术治疗后大部分肩关节功能可恢复到正常状态。顺行髓内钉固定只要提高手术操作技巧,防止医源性损伤,就能明显减少肩关节损伤。Background The humeral shaft fracture is a common injury among upper limbs fractures.There have been documents reporting that the humeral shaft fracture occupy 3% among all fractures.The common operation methods include plate fixation and intramedullary nail fixation. Most scholars think that plate fixation is the golden criteria for comparing all kinds of fixations.And whether the intramedullary nail fixation can affect the shoulder joints functions are still controversial. This thesis has retrospective analysis on 39 patients who performed humeral plate fixation and intramedullary nail fixation in our hospital from January 2001 to September 2012,aiming at studying the effects of shoulder joints functions performed by two internal fixations .Methods General data:39 patients,25 males and 14 females aging 21-75 years old with the average age 43.9 years old were selected as the study subjects.Injury reasons:21 cases were due to falling down,9 cases were due to traffic accident injury,3 cases were due to high falling accident injury,2 cases were due to machine injury,2 cases were due to exercise injury,1 case was due to violence injury,1 case was pathological fracture.According to the AO types,5 cases were with A1 type,6 cases were with A2 type,1 1 cases were with A3 type,1 1 cases were with B1 type,4 cases were with B2 type,2 cases were with C1 type.Open fracture:2 cases were with Gustilo I type,2 cases were with II type,1 case was with IIIa type.The average time from being injured to operation was 1.2 days.Operation methods:All patients were given brachial plexus anesthesia or general anesthesia.1 7 cases in the plate fixation group adopted the incision from anterolateral side,2 cases adopted posterior side.The materials of internal fixation were ordinary plate,dynamic compression plate (DCP)or locking compression plate (LCP).The plate will be fixed according to the AO type principles.At least 3 to 4 screws should be used to the distal and proximal fractures for fixation.The intramedullary nail fixation group sele

关 键 词：肱骨骨折 髓内钉 钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]