本文選題：肩關(guān)節(jié)脫位　切入點(diǎn)：大結(jié)節(jié)骨折　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:肩關(guān)節(jié)脫位伴肱骨大結(jié)節(jié)骨折(greater tuberosity fractures,GTF)在臨床中越來越常見,同時(shí),近年來不斷有該類患者在復(fù)位過程中造成的醫(yī)源性肱骨外科頸骨折(iatrogenic humeral surgical neck fractures,IHSNF)的病例報(bào)道。本文旨在研究肱骨大結(jié)節(jié)骨塊大小與醫(yī)源性肱骨外科頸骨折的發(fā)生之間的關(guān)系,并提出假設(shè):肱骨大結(jié)節(jié)骨塊的大小是引發(fā)肩關(guān)節(jié)脫位伴肱骨大結(jié)節(jié)骨折患者在復(fù)位過程中發(fā)生醫(yī)源性骨折的相關(guān)因素。方法:回顧性研究從2013年7月至2015年7月河北醫(yī)科大學(xué)第三醫(yī)院創(chuàng)傷急救中心收治的肩關(guān)節(jié)脫位伴肱骨大結(jié)節(jié)骨折的74例患者(76例患肩),平均年齡52.4歲(18-84歲)。收集并分析所有患者的基線資料,包括年齡、受傷機(jī)制、患側(cè)、治療等待時(shí)間以及復(fù)位方式。將所有患者分為兩組,即在復(fù)位過程中發(fā)生醫(yī)源性肱骨外科頸骨折組(A組)和未發(fā)生醫(yī)源性肱骨外科頸骨折組(B組)。在常規(guī)肩關(guān)節(jié)正位片中標(biāo)記A,B和C三點(diǎn)。點(diǎn)A為患側(cè)肱骨大結(jié)節(jié)頂點(diǎn),點(diǎn)B為患側(cè)肱骨外科頸及解剖頸之間內(nèi)側(cè)皮質(zhì)上曲率最大處,線段AB與大結(jié)節(jié)骨折線交于點(diǎn)C。分別測量線段AB和AC長度并計(jì)算出AC/AB值。通過受試者工作特征曲線(Receiver Operating Characteristic curve,ROC)計(jì)算出最佳臨界值為0.3982。將所有患者的AC/AB值與最佳臨界值0.3982比較并做相應(yīng)的統(tǒng)計(jì)學(xué)分析去探索肱骨大結(jié)節(jié)骨塊大小與醫(yī)源性骨折的發(fā)生是否存在關(guān)系。結(jié)果:更多的醫(yī)源性肱骨外科頸骨折發(fā)生在具有AC/AB值大于0.3982的患者中。76例患肩中,共有18例發(fā)生了醫(yī)源性骨折(23.7%)。其中,5例具有AC/AB值小于等于0.5,16例具有AC/AB值小于等于0.6。此外,大部分(13例)醫(yī)源性肱骨外科頸骨折發(fā)生在急診行Hippocratic手法復(fù)位時(shí),僅5例(27.78%)發(fā)生在手術(shù)牽引復(fù)位過程中。女性相較于男性具有更大的醫(yī)源性骨折發(fā)生風(fēng)險(xiǎn)(男女比例為1:8)。該類骨折的發(fā)生中,女性患者平均年齡比男性患者更大(女性患者平均59.75歲vs.男性患者平均42歲)。結(jié)論:在肩關(guān)節(jié)脫位伴肱骨大結(jié)節(jié)骨折的患者中,年齡在50歲及以上的女性以及肱骨大結(jié)節(jié)骨塊的大小是復(fù)位過程中易導(dǎo)致醫(yī)源性肱骨外科頸骨折的危險(xiǎn)因素。在肩關(guān)節(jié)正位片中,當(dāng)大結(jié)節(jié)骨塊和外科頸的比值大于0.3982時(shí),患者肩關(guān)節(jié)在復(fù)位尤其是閉合復(fù)位過程中易發(fā)生醫(yī)源性肱骨外科頸骨折。通過測量肱骨大結(jié)節(jié)骨塊的大小,能夠在極大程度上幫助急診和臨床醫(yī)生選擇恰當(dāng)?shù)呐R床治療方案,以預(yù)防醫(yī)源性骨折,取得最佳預(yù)后。
[Abstract]:Objective: shoulder joint dislocation with greater tuberosity of humerus fractures (greater tuberosity, fractures, GTF) in clinical practice is more and more common, at the same time, in recent years there have been iatrogenic surgical neck of the humerus of the patients resulted in reduction in the process of fracture (iatrogenic humeral surgical neck fractures, IHSNF) were reported. The purpose of this paper is to study the relationship between the humerus large nodules occur between bone size and iatrogenic fracture of surgical neck of humerus, and put forward a hypothesis that the greater tuberosity of humerus bone block size is the cause of shoulder joint dislocation with greater tuberosity of humerus in patients with iatrogenic factors related to fracture in the reduction process of fracture dislocation. Methods: retrospective study from July 2013 to July 2015 the Third Hospital of Hebei Medical University trauma emergency center from shoulder joint in 74 cases with fracture of the greater tuberosity patients (76 cases of shoulder), with an average age of 52.4 years (18-84 years) and analyze the collected. Baseline data, including patients age, mechanism of injury, the affected side, waiting time for treatment and reduction. All patients were divided into two groups, namely the occurrence of iatrogenic fracture of surgical neck of humerus during reduction (A group) and no iatrogenic fracture of surgical neck of humerus group (B group). Mark A in conventional shoulder radiographs, B and C three. A in the affected side of the apex of greater tuberosity at B, patients of humeral surgical neck and lateral neck dissection between the medial cortex on the maximal curvature, line AB and line to the greater tuberosity fracture of C. were measured and the length of the AC line AB and the AC/AB value was calculated. The receiver operating characteristic curve (Receiver Operating Characteristic curve, ROC) to calculate the optimal critical value for 0.3982. of all patients with AC/AB 0.3982 and compared the corresponding analysis to explore the greater tuberosity of humerus bone block size and iatrogenic fracture and the optimal critical value The existence of relationship. Results: with AC/AB values greater than 0.3982 of patients in.76 patients with shoulder in iatrogenic fracture of surgical neck of humerus more, there were 18 cases with iatrogenic fracture (23.7%). Among them, 5 cases with AC/AB value less than or equal to 0.5,16 cases with AC/AB value less than or equal in addition 0.6., most (13 cases) occurred in the emergency Hippocratic manual reduction of iatrogenic fracture of surgical neck of humerus, only 5 cases (27.78%) occurred in the operation of traction reduction process. Women than men with iatrogenic greater fracture risk (the ratio of male to female was 1:8). The occurrence of fracture in the average age of female patients more than male patients (female patients with an average of 59.75 years old vs. male patients with an average age of 42). Conclusion: in the shoulder joint dislocation with fracture of greater tuberosity of humerus in women aged 50 and above and the greater tuberosity of humerus bone block size The risk factors of iatrogenic fracture of surgical neck of humerus is easy to cause the reset process. In the shoulder joint radiographs, when the ratio of greater tuberosity fragment and surgical neck is more than 0.3982, especially in patients with shoulder joint reduction and closed reduction is likely to occur in the process of iatrogenic fracture of surgical neck of humerus. By measuring the greater tuberosity of humerus the bone block size, clinical treatment can help clinicians in the selection of appropriate emergency and to a great extent, in order to prevent iatrogenic fracture, achieve the best prognosis.

【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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本文編號(hào)：1729854