[1]沈鹏程 朱立帆 蒋富贵 鞠文 徐能 李晓林.锁定钢板结合重建肱骨内侧柱治疗老年不稳定型肱骨近端骨折的疗效分析[J].中华老年骨科与康复电子杂志,2015,(02):7-12.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
　Shen Pengcheng,Zhu Lifan,Jiang Fugui,et al.Clinical research of locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(02):7-12.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
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锁定钢板结合重建肱骨内侧柱治疗老年不稳定型肱骨近端骨折的疗效分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2015年02期
页码:
7-12
栏目:
骨与创伤
出版日期:
2015-11-05

文章信息/Info

Title:
Clinical research of locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients
作者:
沈鹏程 朱立帆 蒋富贵 鞠文 徐能 李晓林
苏州市吴江区第一人民医院骨科；上海交通大学附属第六人民医院骨科
Author(s):
Shen Pengcheng;  Zhu Lifan;  Jiang Fugui;  Ju Wen;  Xu Neng;  Li Xiaolin
Orthopedic Institute of The First People’s Hospital of Wujiang, ; Orthopedic Institute of The Six Affiliated Hospital of Shanghai Jiao Tong University
关键词:
肩骨折; 　内固定器; 　老年人; 　骨折固定术; 内
Keywords:
　Shoulder fractures; 　Internal fixators; 　Aged; 　Fracture fixation;  internal　
DOI:
10.3877/cma.j.issn.2096-0263.2015.02.002
摘要:
目的　探讨锁定钢板结合肱骨内侧柱重建对老年不稳定型肱骨近端骨折患者术后肩 关节功能恢复的临床效果。方法　回顾性分析2009 年12 月至2014 年12 月间苏州市吴江区第一人 民医院骨科采用锁定钢板或传统钢板治疗肱骨近端骨折且符合纳入及排除标准的患者85 例，其中男 33 例，女52 例，年龄60 ～ 78 岁，平均（65.3±5.4）岁。Neer 骨折分型：二部分骨折37 例，三部 分骨折42 例，四部分骨折6 例。根据患者手术方式及术后影像学检查将患者分为3 组：传统钢板组 （23 例），锁定钢板肱骨近端内侧柱未获重建组（锁定钢板未重建组，34 例）和内侧柱支撑获重建 组（锁定钢板重建组，28 例）。随访并比较3 组患者术后肩关节的Constant 评分变化、肱骨头内翻 角度、术后肱骨头高度比丢失值、二次手术率及并发症发生情况。结果　85 例患者均获得满意随 访，随访时间14 ～ 42 个月，平均（16.3±3.6）个月。末次随访时3 组患者间Constant 评分变化、 肱骨头内翻角度和肱骨头高度比丢失值比较差异均有统计学意义（P ＜ 0.05），其中锁定钢板重建 组Constant 评分升高（33.5±4.2）最高、肱骨头内翻角度（1.1°±3.8°）及肱骨头高度比丢失值（0.02±0.01） 最少，锁定钢板未重建组次之，传统钢板组最差；锁定钢板重建组二次手术率（3.5%）较未重建组 （10.4%）和传统钢板组（30.4%）低，差异具有统计学意义（χ2 =7.774，P=0.021）；锁定钢板重建 组术后并发症发生率为7.1%，未重建组为29.4%，传统钢板组为34.7%。结论　锁定钢板结合重建 内侧柱支撑固定肱骨近端骨折可减少术后肱骨头复位丢失和肱骨头内翻角度，从而提高术后肩关节 功能的恢复质量，使老年不稳定型肱骨近端骨折取得满意的疗效。
Abstract:
　Objective　To study the clinical efficacy of the recovery of shoulder joint function and the maintenance of the fracture fixation after treatment by locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients. Methods A retrospective analysis was performed on the use of locking plate or traditional plate and follow-up of 85 patients with proximal humeral fractures between December 2009 and December 2014. The paitients included 33 males and 52 females, ranging in age from 60 to 78 years, at an average of (65.3±5.4) years. There were 37 cases of two-part fractures, 42 cases of three-part fractures , and 6 cases of four-part fractures according to Neer classification. The patients were divided into three groups according to surgical procedure and imaging examination, including traditional plate group (23 cases), locking plate without medial column reconstruction group (locking plate without reconstruction group, 34 cases) and locking plate with medial column reconstruction group (locking plate with reconstruction group, 28 cases). The change of postoperative Constant score of shoulder joint, humerus head angle, the loss of humerus head height and complications were measured. Results All of the 85 cases were followed-up after postoperative 14-42 months, with an average of (16.3±3.6) months, and all cases obtained satisfactory results. The differences in Constant score, humerus head varus angle, and the loss of humerus head height among the 3 groups were statistically significant (P<0.05). Locking plate with reconstruction group got the highest Constant score (33.5±4.2), and lowest head of the humerus varus angle (1.1°±3.8°) and loss of humerus head height (0.02±0.01), followed by locking plate without reconstruction group and the data of traditional plate group is the worst. The rate of secondary surgery (3.5%) in reconstruction group were less than group without reconstruction (10.4%) and traditional plate group (30.4%), and the difference had statistical significance (χ2=7.774, P=0.021). The rate of postoperative complications was 7.1% in reconstruction group, comparing with 29.4% in group without reconstruction and 34.7% in traditional plate group. Conclusion Locking plate internal fixation and reconstructing the medial column support could restore the mechanical stability of the proximal humeral fractures, reduce the occurrence of complications and improve the quality and recovery of shoulder joint function in elderly patients.

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备注/Memo:
苏州市科技局项目（SYS201502）
更新日期/Last Update: 2015-12-30