摘要
目的探讨在半肩关节置换术治疗复杂肱骨近端骨折术中应用Nice结固定修复大、小结节对结节愈合情况的疗效。方法回顾性分析2016年5月1日至2019年5月1日北京大学人民医院创伤骨科收治32例复杂肱骨近端骨折患者资料,所有患者在行半肩关节置换术中使用Nice结固定修复大、小结节。男6例,女26例;年龄60~90岁,平均74.9岁。骨折Neer分型:三部分合并脱位4例,四部分20例,四部分合并脱位8例。术后1、2、3、6、12个月门诊复查肩关节X线片,检查患者肩关节活动度,评估疼痛视觉模拟评分(VAS)及肩关节Constant-Murley评分,根据X线片记录结节愈合及相关并发症发生情况。结果32例患者术后获12~25个月(平均17.8个月)随访。术后12个月32例患者肩关节活动范围:前屈80°~155°,平均131.3°;外展80°~155°,平均126.9°;外旋30°~60°,平均48.4°;内旋平均为L2椎椎体水平;VAS评分为0~5分,平均0.9分;Constant-Murley评分为58~96分,平均83.4分;患者满意率为87.5%(28/32)。6例出现结节相关并发症,发生率为18.8%(6/32),其中3例大结节吸收,3例大结节出现移位。无一例患者出现感染、假体松动等并发症。结论在半肩关节置换术治疗复杂肱骨近端骨折术中使用Nice结固定大、小结节较稳定,效果确切,结节相关并发症发生率低。
Objective To explore the curative effects of Nice knot fixation on tuberosity healing in hemiarthroplasty for complex proximal humeral fractures.Methods A retrospective analysis was conducted of the eligible 32 complex proximal humeral fractures which had been treated at Department of Trauma and Orthopedics,Peking University People's Hospital between May 1,2016 and May 1,2019.Nice knot fixation was used to repair greater and lesser tuberosities in hemiarthroplasty for all the patients.There were 6 males and 26 females,aged from 60 to 90 years(mean,74.9 years).By the Neer classification,there were 4 three-part fractures combined with dislocation,20 four-part fractures,and 8 four-part fractures combined with dislocation.Shoulder joint X-rays were taken at postoperative 1,2,3,6,and 12 months at the outpatient clinic to evaluate the patients'shoulder joint mobility,visual analog scale(VAS)pain score and Constant-Murley shoulder score.Tuberosity healing was assessed based on the X-rays and related complications were recorded.Results The 32 patients received complete follow-up for 12 to 25 months(average,17.82 months).At the 12-month follow-up,their shoulder flexion averaged 131.3°(from 80°to 155°),abduction 126.9°(from 80°to 155°),external rotation 48.4°(from 30°to 60°),internal rotation the L2 level,VAS pain score 0.9(from 0 to 5),and Constant-Murley score 83.4(from 58 to 96).The rate of patient satisfaction was 87.5%(28/32).Tuberosity-related complications were observed in 6 cases with an incidence of 18.8%.Complications like infection and prosthetic loosening were found in none of the patients.Conclusion In hemiarthroplasty for complex proximal humeral fractures,application of Nice knot to fixate greater and lesser tuberosities can lead to rigid fixation,definite curative effects and a low incidence of tuberosity-related complications.
作者
马明太
曾松录
居家宝
张一翀
陈建海
张殿英
付中国
Ma Mingtai;Zeng Songlu;Ju Jiabao;Zhang Yichong;Chen Jianhai;Zhang Dianying;Fu Zhongguo(Department of Trauma and Orthopedics,Peking University People's Hospital,Key Laboratory of Trauma Treatment and Nerve Regeneration of Education Ministry,National Trauma Medical Center,Beijing 100044,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第2期127-131,共5页
Chinese Journal of Orthopaedic Trauma
关键词
肩骨折
肩脱位
关节成形术
置换
Nice结
Shoulder fractures
Shoulder dislocation
Arthroplasty,replacement
Nice knot
