【摘要】：目的:回顧性分析采用鎖定鋼板治療非骨質(zhì)疏松性三部分和四部分肱骨近端骨折的臨床效果。方法:回顧性評估鎖定鋼板治療非骨質(zhì)疏松性三部分和四部分肱骨近端骨折的臨床效果,統(tǒng)計患肢的肩關(guān)節(jié)活動度、臨床評分、視覺模擬評分(visual analogue scale,VAS)和影像學檢查的結(jié)果。結(jié)果:自2007年1月至2014年10月,采用鎖定鋼板共治療107例新鮮非骨質(zhì)疏松性三部分和四部分肱骨近端骨折,其中67例患者完成至少2年的隨訪,平均隨訪時間(43.9±23.3)個月(24~108個月)。在最終隨訪時,Constant評分平均為(87.1±11.7)分(51~100分),加州大學肩關(guān)節(jié)評分(the University of California at Los Angeles shoulder score,UCLA)平均為(30.5±3.9)分(18~35分),VAS疼痛評分為(1±2)分(0~7分);主動前屈上舉為159.0°±19.3°(80°~180°),體側(cè)外旋為36.8°±19.5°(0°~80°),體側(cè)內(nèi)旋為T11水平(T2~LS水平)。術(shù)后11例患者出現(xiàn)并發(fā)癥,包括5例螺釘穿出(7.5%),9例肱骨頭缺血壞死(13.4%)及5例創(chuàng)傷性骨性關(guān)節(jié)炎(7.5%),6例合并兩種或兩種以上并發(fā)癥。三部分骨折和四部分骨折術(shù)后患者的肩關(guān)節(jié)活動度、臨床評分和VAS疼痛評分差異無統(tǒng)計學意義。四部分骨折的術(shù)后并發(fā)癥率及術(shù)后肱骨頭缺血壞死概率顯著高于三部分骨折。結(jié)論:應用肱骨近端鎖定鋼板治療非骨質(zhì)疏松性三、四部分復雜肱骨近端骨折可得到滿意的術(shù)后肩關(guān)節(jié)功能恢復,嚴格的適應證選擇與精細的手術(shù)操作是取得手術(shù)成功的關(guān)鍵,骨折的復雜程度亦對術(shù)后結(jié)果產(chǎn)生影響,四部分骨折的并發(fā)癥發(fā)生率以及術(shù)后肱骨頭缺血壞死率高于三部分骨折。
[Abstract]:Objective: to retrospectively analyze the clinical effect of locking plate in the treatment of non-osteoporosis fracture of proximal humerus. Methods: the clinical effects of locking plate in the treatment of nonosteoporotic proximal humerus fractures were retrospectively evaluated. The shoulder motion, clinical score, visual analogue score (visual analogue scale,VAS) and imaging findings of the affected limbs were analyzed. Results: from January 2007 to October 2014, 107 cases of fresh nonosteoporotic proximal humerus fractures were treated with locking plate. 67 of them were followed up for at least 2 years, with an average follow-up time of (43.9 鹵23.3) months (24 ~ 108 months). At final follow-up, the average Constant score was (87.1 鹵11.7) (51-100), the UCLA shoulder score (the University of California at Los Angeles shoulder score,UCLA) averaged (30.5 鹵3.9) (18-35), the), VAS pain score was (1 鹵2) (0-7), the active flexion was 159.0 擄鹵19.3 擄(80 擄~ 180 擄), the lateral extroversion was 36.8 擄鹵19.5 擄(0 擄~ 80 擄), and the intra-lateral rotation was 36.8 擄鹵19.5 擄(0 擄~ 80 擄). The rotation is T11 (T2~LS level). Postoperative complications occurred in 11 patients, including 5 cases of screw perforation (7.5%), 9 cases of ischemic necrosis of the head of humerus (13.4%) and 5 cases of traumatic osteoarthritis (7.5%), and 6 cases were complicated with two or more kinds of complications. There was no significant difference in shoulder motion, clinical score and VAS pain score between patients with three and four parts fracture. The rate of postoperative complications and the probability of ischemic necrosis of humerus head were significantly higher in four-part fractures than in three-part fractures. Conclusion: using locking plate of proximal humerus to treat nonosteoporotic fracture of proximal humerus can obtain satisfactory recovery of shoulder joint function after operation. Strict indication selection and fine operation are the key to successful operation. The complication rate of four parts fracture and the rate of ischemic necrosis of humeral head were higher than that of three parts fracture.
【作者單位】： 北京積水潭醫(yī)院運動損傷科;
【分類號】：R687.3

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