摘要
目的探讨对青壮年NeerⅣ型肱骨近端骨折采用锁定接骨板内固定术中复位、固定及术后康复的方法,观察其疗效。方法采用切开复位、锁定接骨板内固定治疗青壮年NeerⅣ型肱骨近端骨折26例,其中18例合并有肱骨头脱位。手术取肩关节前内侧的三角肌-胸大肌间隙入路显露,根据肩部关节囊等软组织的完整与否分别采用囊外和囊内复位方法,首先将脱位的肱骨头复位,然后根据骨折移位情况等决定多个骨折部分的复位顺序,使用克氏针临时固定骨折,解剖型锁定接骨板置于肱骨近端外侧固定骨折。术后在康复治疗师指导下按照制定的康复方法进行严格的康复训练。结果 26例患者术后随访时间为12个月~5年,平均38个月。肩部肌肉有萎缩者3例,以切口部位明显,肩部外形欠佳。肩关节活动到术后12周时大部分恢复正常,有2例肩关节仍有活动受限。随访中没有发生肩关节再脱位和骨折不愈合情况。4例患者肱骨头高度出现丢失;1例肱骨头部有螺丝钉穿出肱骨头关节面;2例肱骨头缺血性坏死,肱骨头坏死率为7.69%,发现坏死时间分别在术后6个月和15个月。26例患者在末次随访时美国肩与肘协会评分系统(American shoulder and elbow surgeons evaluation form,ASES)为62~100分,平均92.8分;Constant-Murley评分68~100分,平均91.9分;按Neer评分结果进行疗效评价:优18例,良6例,可1例,差1例,优良率为92.3%。结论青壮年NeerⅣ型肱骨近端骨折多为高能量损伤所致,合并肱骨头脱位的比例高。对青壮年NeerⅣ型肱骨近端骨折采用切开复位、锁定接骨板内固定治疗,预后较好。原始损伤程度,手术治疗方法的合理性以及对术后康复治疗的重视程度等对临床疗效有影响。大结节位置偏高时出现肩部撞击征阳性,将会长期影响肩关节的外展及上举活动;不重视肱骨近端内侧柱的重建可能是导致术后肱骨头内翻、下沉的原�
Objective To discuss the methods of reduction,fixation,and postoperative recovery in the treatment for adult Neer Ⅳ proximal humerus fracture using the locking plate internal fixation,and to observe the treatment effect.Methods The open reduction and locking plate internal fixation were used to treat adult Neer Ⅳ proximal humerus fractures.This treatment had been used in 26 cases,in which 18 cases were associated with humeral head dislocation.In the operation,the junction between the deltoid and the pectoralis major was exposed.Then based on the integrity of soft tissues like the shoulder articular capsule,the extracapsular reduction method or intracapsular reduction method was adopted.We restored the dislocated humeral head to its normal position.Then fractures were reducted based on circumstances such as bone displacement.K-wires were usedfor temporary fixation.We placed the anatomical lock plate at the lateral sideof proximal humerus to fix the fracture.After operation,patients underwent strict rehabilitation training under the therapist＇s guidance.Results Follow-up of patients ranges from 12 months to 5 years with anaverage of 38 months.Among them,three patients hadmuscular atrophy in the shoulder.And the shoulder was not of good shape.Allshoulder joints have recovered in 12 weeks after operation excepttwo.No patients suffered from shoulder joint re-dislocation or nonunion.Humerus height loss occurred in four cases.In one case,the humeral head screw protruded from the articular surface.In two cases,patients developed humeral head ischemic necrosis respectively after six months and 15 months.The necrosis rate was 7.69%.In the last follow-up,ASES rates of the 26 patients ranged from 62 to 100 with an average of 92.8;and their Constant-Murley rates range from 68 to 100 with an average of 91.9.According to the Neer results,18 cases were rated excellent,6 good,1 ordinary,and 1 poor.The rate ofexcellent and good were 92.3%.Conclusion Adult Neer Ⅳ proximal humerus fractures are mostly caused by high energy i
出处
《实用骨科杂志》
2017年第7期577-582,共6页
Journal of Practical Orthopaedics
关键词
肱骨近端骨折
锁定接骨板
内固定
疗效观察
proximal humerus fracture
locking plate
internal fixation
clinical observation
