本文選題：肱骨近端骨折 + 鎖定鋼板�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:肱骨近端骨折屬于成人的上肢骨折中較為常見的類型之一,發(fā)生比例在肱骨骨折中占到將近一半,影響其發(fā)生的因素和骨質(zhì)疏松有很大關(guān)系,在治療方法上有多種的選擇。就目前而言,肱骨近端鎖定鋼板系統(tǒng)的開展使用,給肱骨近端骨折的治療帶來了很好的效果。但由于肱骨近端的解剖特點(diǎn)及血供情況,亦有出現(xiàn)并發(fā)癥的可能,其中最常見的是螺釘切出關(guān)節(jié)面。本文通過研究在肱骨近端骨折運(yùn)用鎖定鋼板治療過程中,測量并控制類尖頂距的數(shù)值,探討類尖頂距對(duì)于肱骨近端骨折術(shù)后骨折復(fù)位的質(zhì)量及減少術(shù)后并發(fā)癥的影響。方法:選取因肱骨近端骨折接受鎖定鋼板治療的124例患者,根據(jù)Neer分型法分類,經(jīng)過術(shù)前評(píng)估,臂叢神經(jīng)阻滯麻醉或靜吸復(fù)合麻醉下,選擇三角肌-胸大肌入路,手術(shù)方法切開復(fù)位,肱骨近端采取鎖定鋼板固定,術(shù)后均拍攝肱骨近端正、側(cè)位X線片,測量類尖頂距數(shù)值。依據(jù)所測得的類尖頂距數(shù)值將其分成兩組,第一組類尖頂距小于35mm,第二組類尖頂距大于35mm,觀察骨折的復(fù)位質(zhì)量,并跟蹤隨訪每位患者的治療效果。骨折復(fù)位效果的評(píng)價(jià)標(biāo)準(zhǔn):復(fù)位優(yōu),在正側(cè)位X線片上骨折均能達(dá)到解剖學(xué)復(fù)位;復(fù)位中:在正側(cè)位X線片上骨折力線復(fù)位良好,但內(nèi)側(cè)、下側(cè)皮質(zhì)復(fù)位稍差,主要的骨折塊移位小于2mm;復(fù)位差:在正側(cè)位X線片上骨折力線的復(fù)位較差,骨折塊分離明顯,內(nèi)側(cè)、下側(cè)的骨皮質(zhì)缺損比較多。結(jié)果:肱骨近端骨折術(shù)后的跟蹤隨訪時(shí)間10個(gè)月~18個(gè)月,平均為14個(gè)月,直到隨訪患者的骨折完全愈合或者X線片上表明內(nèi)固定未成功。本組病例中類尖頂距小于35mm(第一組)65例,類尖頂距大于35mm(第二組)59例。組一中骨折復(fù)位優(yōu)者39例,其中發(fā)生肱骨頭內(nèi)翻的2例(5.1%),無螺釘切出者;骨折復(fù)位中者18例,其中發(fā)生肱骨頭內(nèi)翻的5例(27.8%),無螺釘切除者;骨折復(fù)位差者8例,其中發(fā)生肱骨頭內(nèi)翻的4例(50%),螺釘切出1例(12.5%)。組二中骨折復(fù)位優(yōu)者30例,其中發(fā)生肱骨頭內(nèi)翻的4例(13.3%),無螺釘切出者;骨折復(fù)位中者17例,其中發(fā)生肱骨頭內(nèi)翻的7例(41.2%),螺釘切出2例(11.8%);骨折復(fù)位差者12例,其中肱骨頭內(nèi)翻的6例(50.0%),螺釘切出的4例(33.3%)。組二的肱骨頭內(nèi)翻及螺釘切出的術(shù)后并發(fā)癥發(fā)生率顯著高于組一,具有統(tǒng)計(jì)學(xué)意義(X2=8.45,P0.01)。每組內(nèi)比較,隨著骨折復(fù)位質(zhì)量的下降,肱骨頭內(nèi)翻及螺釘切出的并發(fā)癥的發(fā)生率隨之增高,統(tǒng)計(jì)學(xué)檢查有顯著差異,P0.05。結(jié)論:本課題通過對(duì)鎖定鋼板治療肱骨近端骨折的研究,及類尖頂距的測量,得出以下結(jié)論:1類尖頂距可以快速有效的判斷螺釘切出肱骨頭的可能性,類尖頂距值大于35mm,術(shù)后螺釘切出肱骨頭的發(fā)生率會(huì)明顯增高。2骨折的復(fù)位質(zhì)量如何,直接關(guān)系到運(yùn)用鎖定鋼板治療肱骨近端骨折的治療效果。3在運(yùn)用鎖定鋼板治療肱骨近端骨折的過程中,熟悉掌握類尖頂距的解剖學(xué)特點(diǎn),手術(shù)中在C型臂的透視下準(zhǔn)確掌握內(nèi)固定螺釘?shù)奈恢?從而提高骨折斷端的復(fù)位質(zhì)量,可顯著降低多種術(shù)后并發(fā)癥的發(fā)生率。
[Abstract]:Objective: the proximal humerus fracture is one of the most common types of upper limb fractures in adults, which accounts for nearly half of the fracture of the humerus. The factors affecting the occurrence of the fracture are closely related to the osteoporosis, and there are a variety of options in the treatment. The treatment of end fracture has a good effect. But because of the anatomical characteristics of the proximal humerus and the condition of blood supply, there is also a possibility of complications. The most common one is to cut the articular surface of the screw. In this paper, the value of the spires was measured and controlled in the treatment process of the proximal humerus fracture with locking plate. Methods: 124 patients with proximal humerus fracture treated with locking plate were selected for the treatment of proximal humerus fractures. According to the classification of the Neer classification, the surgical method was selected by the preoperation assessment, the brachial plexus block anesthesia or the static inhalation combined anesthesia. The proximal humerus was fixed with locking plate, and the proximal humerus was photographed near the proximal end of the humerus, and the lateral X ray was taken to measure the number of the spires. The first group was less than 35mm and the second groups of spires were greater than 35mm, and the quality of the fracture reduction was observed and followed up for each patient. Therapeutic effect. Evaluation criteria of fracture reduction effect: excellent reduction and anatomical reduction on normal lateral X-ray films; reduction of fracture force line in positive lateral X ray is good, but medial, inferior lateral cortex is slightly inferior, main fracture block is less than 2mm; reduction is poor: the reduction of fracture force line on lateral X-ray film is poor. Results: the follow-up time after the proximal humeral fracture was 10 months ~18 months, averaging 14 months, until the fracture was completely healed or the X-ray showed that the internal fixation was not successful. In this group, the spires were less than 35mm (group 1), 65 cases, the spires like spires. More than 35mm (group second) 59 cases, 39 cases of one middle fracture reduction, 2 cases of humeral head internal varus (5.1%), no screw cut, 18 cases of fracture reduction, 5 cases of humeral head varus (27.8%), no screw excision, 8 fracture reduction, 4 cases (50%) of humeral head varus, 1 cases (12.5%) with screw cut. Group two. There were 30 cases of fracture reduction, including 4 cases (13.3%) of humeral head internal varus, 17 cases of fracture reduction, 7 cases of humeral head internal varus (41.2%), 2 screw cut (11.8%), 6 cases (50%) of humeral head internal varus, 4 cases (33.3%), humeral head varus and screws. The incidence of postoperative complications was significantly higher than that in the group one, with statistical significance (X2=8.45, P0.01). With the reduction of fracture reduction, the incidence of complications of humeral head varus and screws increased with the decrease of fracture reduction, and there was a significant difference in statistical examination, P0.05. conclusion: this subject was treated by locking plate for the treatment of proximal humerus. It is concluded that the 1 kind of spires can quickly and effectively determine the possibility of the screw cut out of the humeral head, and the value of the spires is greater than 35mm. The incidence of the humeral head after the operation can obviously increase the quality of the reduction of the.2 fracture, which is directly related to the treatment of the proximal humerus bone with locking plate. During the treatment of proximal humerus fracture with locking plate,.3 is familiar with the anatomical characteristics of the spires and the position of internal fixation screws under the perspective of the C arm in the operation, thus improving the quality of the broken end of the fracture, and significantly reducing the incidence of postoperative complications.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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