摘要
目的探讨肱骨近端内侧柱的不同支撑重建对锁定钢板治疗肱骨近端骨折的稳定性和预后的影响。方法2005年6月至2011年6月采用锁定钢板治疗并完整随访130例肱骨近端骨折患者，男46例，女84例；年龄18～88岁，平均56．1岁。骨折根据Neer分型：二部分骨折56例，三部分骨折52例，四部分骨折22例。根据肱骨近端内侧柱支撑重建情况分为4组：骨皮质解剖复位组60例，多枚螺钉置入组12例，单枚螺钉置入组17例和无支撑重建组41例。末次随访时比较4组患者的肩关节功能constant评分、视觉模拟评分（VAS）、肱骨头内翻角度、并发症发生率及二次手术率等。结果130例患者术后获12。42个月（平均18．8个月）随访。末次随访时骨皮质解剖复位组、多枚螺钉置人组、单枚螺钉置入组及无支撑重建组的Constant评分平均分别为（81．2±12．7）、（75．54-9．7）、（69．4±12．1）、（67．5±11．6）分，VAS评分分别为（1．4±1．9）、（1．74-1．6）、（2．54-2．2）及（3．24-2．4）分，肱骨头内翻角平均分别为0．8。4-1．0。、1．4。4-2．3。、3．4。4-6．8。及4．4。4-4．0。，以上项目，骨皮质解剖复位组与多枚螺钉置入组比较差异均无统计学意义（P〉0．05），骨皮质解剖复位组与单枚螺钉置人组、无支撑重建组差异均有统计学意义（P〈0．05），多枚螺钉置入组与无支撑重建组差异有统计学意义（P〈0．05）。4组患者术后并发症发生率与二次手术率两两比较差异均无统计学意义（P〉0．05）。结论锁定钢板治疗肱骨近端骨折时，采用内侧骨皮质支撑重建肱骨近端内侧柱支撑具有较佳的固定效果；当肱骨近端内侧粉碎性骨折、骨缺损或内侧骨皮质难于复位时，也可通过多枚内侧支撑螺钉重建肱骨近端内侧柱支撑，以获稳定固定。
Objective To investigate the effects of different reconstructions of the medial support on the clinical outcomes of locked plating of proximal humeral fractures. Methods Between June 2005 and June 2011, 130 patients underwent locked plating of proximal humerus fracture and completed follow-ups in our department. They were 46 men and 84 women, 18 to 88 years of age （average, 56.1 years）. By the Neer classification, 56 cases were two-part fractures, 52 three-part fractures and 22 four-part fractures. They were categorized into 4 groups according to the 4 different reconstructions of medial support of the proximal humerus. In the CS （cortical support） group, 60 patients had the reconstruction by anatomic reduction of the cortical bone; in the MS （multi-screw support） group, 12 patients had the reconstruction by insertion of more than 2 medial support screws; in the SS （single-screw support） group, 17 patients had the reconstruction by insertion of only one medial support screw; in the NS group, 41 patients had no reconstruction of medial support of the proximal humerus. The postoperative Constant scores of the shoulder function, visual analog scale （VAS） pain scores, loss of the head-shaft angle, complications and reoperation rates were compared among the 4 groups. Results The follow-ups for the patients ranged from 12 to 42 months （mean, 18.8 months）. At the last follow-up, the CS, MS, SS and NS groups had a mean Constant score of 81.2 ＋ 12. 7,75.5~9.7, 69.4~12.1 and 67.5~11.6, respectively; a mean VAS score of 1.4＋1.9, 1.7~1.6, 2.5 ~2. 2 and 3.2 ~2. 4, respectively; a mean loss of the head-shaft angle of 0. 8~~ 1.0~, 1.4~~2.3~, 3.4~ ~ 6. 8~ and 4.4~ _＋ 4. 0~, respectively. With respect to the 3 indexes, there were no significant differ- ences between the CS and MS groups （ P 〉 0. 05）, there were significant differences between the CS group and respectively the SS and NS groups （ P 〈 0. 05）, and there were also significant differences between the MS and NS groups （ P 〈
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第1期6-11,共6页
Chinese Journal of Orthopaedic Trauma
基金
上海市自然科学基金（12ZR1422300）
关键词
肩关节
肱骨骨折
骨折固定术
内
骨板
Shoulder joint
Humeral fractures
Fracture fixation, internal
Bone plates
