本文選題：肱骨近端骨折 + 肱骨后傾角�。� 參考：《上海交通大學(xué)》2015年碩士論文

【摘要】：【目的】使用CT重建的方法測(cè)量鎖定鋼板治療的患者肱骨近端角度的變化,并使用模型骨重建骨折畸形模型,探討肱骨近端角度變化對(duì)骨折預(yù)后的影響原因。【方法】在第一部分實(shí)驗(yàn)中,將CT重建測(cè)量技術(shù)結(jié)合降噪、去除偽影等方法,首次應(yīng)用于鎖定鋼板治療的肱骨近端骨折患者的隨訪中。從2012年9月至2014年10月隨訪了54例鎖定鋼板(AO PHILOS)治療的肱骨近端骨折患者。其中38患者完成12個(gè)月及以上隨訪,使用CT三維重建法測(cè)量患者雙側(cè)肱骨近端后傾角和頸干角。并記錄患者視覺(jué)模擬評(píng)分(VAS)、肩關(guān)節(jié)功能Constant評(píng)分及并發(fā)癥等。通過(guò)雙側(cè)肩關(guān)節(jié)比較,將患者分為肱骨后傾角增加組、后傾角減小組及頸干角增大組、頸干角減小組。在第二部分實(shí)驗(yàn)中,將人工骨在外科頸處截骨,使用鎖定鋼板(AO PHILOS)在不同后傾角度下固定,建立五組各十具肱骨后傾角畸形模型,分別為:后傾20°組、后傾20°組、正常組、前傾10°組、前傾20°組,并測(cè)量不同模型上每個(gè)鋼板鎖定孔對(duì)應(yīng)的鎖定螺釘最大長(zhǎng)度,最后統(tǒng)計(jì)分析肱骨傾角的改變是否影響了鎖定鋼板上頭螺釘?shù)淖畲箝L(zhǎng)度。【結(jié)果】患側(cè)肩肱骨后傾角與健側(cè)相比較,兩者差別無(wú)統(tǒng)計(jì)學(xué)意義,但患側(cè)肩肱骨頸干角顯著大于健側(cè)肩。三種骨折類(lèi)型在組間分布無(wú)顯著差異。在肱骨頸干角增大組與減小組之間末次隨訪VAS評(píng)分,并發(fā)癥發(fā)生率及末次隨訪Constant評(píng)分差異均無(wú)統(tǒng)計(jì)學(xué)意義。肱骨后傾角減小組的術(shù)后并發(fā)癥發(fā)生率明顯較低且末次隨訪Constant評(píng)分顯著高于肱骨后傾角增大組。肱骨后傾角前傾20°組和后傾20°組的螺釘總體長(zhǎng)度均顯著小于其他三組,其中前下方向的兩顆螺釘最大長(zhǎng)度均顯著低于其他組。【結(jié)論】與健側(cè)肩關(guān)節(jié)相比,患側(cè)肱骨頸干角增大或減小對(duì)接受鎖定鋼板治療的患者預(yù)后影響不大,但肱骨后傾角相較于健側(cè)增大是患者預(yù)后的危險(xiǎn)因素之一。肱骨后傾角改變達(dá)到20°時(shí)會(huì)顯著縮短肱骨頭前下方向的螺釘最大長(zhǎng)度。
[Abstract]:[objective] to measure the changes of proximal humerus angle in patients treated with locking plate with CT reconstruction, and to reconstruct the fracture deformity model with model bone.To investigate the influence of proximal humerus angle change on fracture prognosis. [methods] in the first part of the experiment, CT reconstruction technique was combined with noise reduction, artifact removal, etc.It was first used in the follow-up of patients with proximal humerus fracture treated with locking plate.From September 2012 to October 2014, 54 patients with proximal humeral fractures treated with locked plate or AO PHILOS were followed up.38 patients were followed up for 12 months or more. The posterior inclination and neck shaft angle of bilateral humerus were measured by CT 3D reconstruction.Visual analogue score (VAS), shoulder function score (Constant) and complications were recorded.According to the bilateral shoulder joint comparison, the patients were divided into three groups: the humeral posterior inclination increased group, the posterior inclination decreased group and the neck trunk angle increased group, and the cervical trunk angle decreased group.In the second part of the experiment, the artificial bone was cut off at the surgical neck and fixed with locking plate (AO PHILOS) at different backward tilting angles. Ten humeral obliquity deformity models were established in each of the five groups. They were: backward tilting 20 擄group, backward 20 擄group, normal group.The maximum length of locking screws corresponding to each locking hole of steel plate was measured in 10 擄forward tilting group and 20 擄forward tilting group.Finally, statistical analysis was made on whether the change of humeral obliquity affected the maximum length of head screw on locking plate. [results] there was no significant difference between the affected shoulder and humeral posterior angle and the healthy side.But the humerus neck shaft angle of the affected side shoulder was significantly higher than that of the healthy side shoulder.There was no significant difference in the distribution of the three fracture types among groups.There was no significant difference in VAS score, complication rate and Constant score between the group with increased humeral neck shaft angle and the subtraction group.The incidence of postoperative complications in the group with reduced posterior humeral inclination was significantly lower than that in the group with increased posterior inclination of humerus. The Constant score of the last follow-up was significantly higher than that of the group with increased posterior humeral inclination.The total length of the screws in the 20 擄and 20 擄backward tilting groups was significantly smaller than that in the other three groups, and the maximum length of the two screws in the anterior and lower direction was significantly lower than that in the other groups. [conclusion] compared with the healthy shoulder joint, the maximum length of the two screws was significantly lower than that of the other two groups.The increase or decrease of the neck shaft angle of the affected humerus had little influence on the prognosis of the patients treated with locking plate, but the humeral posterior inclination angle was one of the risk factors of prognosis compared with the healthy side.The maximum length of the screw in the anterior and lower direction of the head of the humerus was significantly shortened when the humeral posterior inclination reached 20 擄.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.32

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