摘要
目的探讨经三角肌入路锁定钢板内固定治疗老年外展嵌插型肱骨近端骨折的临床疗效。方法采用回顾性病例系列研究分析2016年9月—2018年3月解放军中部战区总医院收治的25例老年外展嵌插型肱骨近端骨折患者临床资料,其中男7例,女18例;年龄60~81岁[(67.9±9.1)岁]。按照肱骨近端骨折Neer分型:三部分骨折21例,四部分骨折4例。均采用经三角肌的微创切口,应用锁定钢板行内固定治疗。术后指导患者康复锻炼。记录切口总长度、手术时间、术中出血量,观察骨折愈合情况,比较末次随访时患侧与健侧肩关节活动度及外展肌力,末次随访时采用Constant-Murley评分评价肩关节功能恢复情况。观察术后并发症情况。结果25例患者均获随访12~23个月[(14.6±3.2)个月]。切口总长度6.4~8.8 cm[(7.1±1.2)cm];手术时间68~106 min[(84.0±5.6)min];术中出血量55~95 ml[(62.5±16.4)ml]。术后骨折线均获良好复位,术后6个月骨折均获骨性愈合,末次随访患侧肩关节前屈、外展、内旋和外展肌力与健侧比较差异均无统计学意义(P<0.05)。末次随访Constant-Murley评分:优9例,良13例,可3例,优良率88%。结论采用经三角肌入路锁定钢板内固定治疗老年外展嵌插型肱骨近端骨折,手术创伤小,手术时间短,术中出血量少,术后并发症发生率低,可促进肩关节活动度和功能恢复。
Objective To investigate the clinical effect of treatment of valgus impacted proximal humeral fracture in elderly patients with locking plate internal fixation through deltoid approach.Methods A retrospective case series study was carried out to analyze the clinical data of 25 elderly patients with valgus impacted proximal humeral fracture hospitalized in Central Theater General Hospital of PLA from September 2016 to March 2018,including 7 males and 18 females,aged 60-81 years[(67.9±9.1)years].According to Neer classification,21 patients were with three part proximal humeral fracture and 4 with four part fracture.All patients were treated by internal fixation with locking plate through deltoid approach.Rehabilitation exercise training was done after operation.Total length of incision,operation time,intraoperative bleeding volume and fracture healing were recorded.At the last follow-up,the range of motion and abductor muscle strength of the shoulder joint between the affected side and the healthy side were compared,joint function was evaluated using the Constant Murley score,and the postoperative complications were observed.Results All patients were followed up for 12-23 months[(14.6±3.2)months].Total length of incision was 6.4-8.8 cm[(7.1±1.2)cm].Operation time was 68-106 minutes[(84.0±5.6)minutes].Intraoperative bleeding volume was 55-95 ml[(62.5±16.4)ml].All the fracture lines were well reduced and bony union was observed in all patients at popstoperative 6 months.At the last follow-up,there was no significant difference in flexion,abduction,pronation range and abductor muscle strength between the affected side and the healthy side(P<0.05).At the last follow-up,the Constant Murley score of shoulder joint function was excellent in 9 patients,good in 13,fair in 3,with excellent and good rate of 88%.There was no subacromial impact,humeral head necrosis or other complications after operation.Conclusion Locking plate through deltoid approach in treatment of valgus impacted proximal humeral fracture in the elder
作者
王华松
杨晨曦
吴刚
刘曦明
丰瑞兵
庞炯宇
Wang Huasong;Yang Chenxi;Wu Gang;Liu Ximing;Feng Ruibing;Pang Jiongyu(Department of Orthopedics,Central Theater General Hospital of PIA,Wuhan 430070,China;First Clinical College,Hubei University of Traditional Chinese Medicine,Wuhan 430061,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第3期228-232,共5页
Chinese Journal of Trauma
关键词
肱骨骨折
外科手术
微创性
老年人
Humeral fractures
Surgical procedures
Minimally Invasive
Aged
