摘要
目的:探究内侧柱支撑螺钉数目对切开复位锁定钢板固定治疗肱骨近端骨折的生物力学以及患者临床恢复影响。方法:将40个人工合成右侧肱骨制成外科颈骨折模型,平均分成a、b、c、d 4组,分别予以0、1、2、3枚内侧支撑螺钉支撑,采用生物力学试验机进行轴向压缩、剪切力、抗扭测试;另选取2016年1月—2021年6月160例行肱骨近端骨折行切开复位锁定钢板固定治疗患者,采用随机信封法分为A组、B组、C组、D组各40例,术中选择内侧支撑螺钉置入数目分别为0、1、2、3枚。术后随访6个月,比较4组骨折愈合时间、肱骨头高度丢失值、术后不同时间点功能恢复情况(肩关节Constant-Murley评分)以及并发症发生情况。结果:4组轴向压缩测试最大载荷及抗压刚度、剪切力测试最大载荷及抗压刚度、抗扭测试最大扭转及抗扭刚度比较,差异有统计学意义(P<0.05),且d组>c组>b组>a组。4组骨折愈合时间比较,差异无统计学意义(P>0.05),但4组肱骨头高度丢失值比较,差异有统计学意义(P<0.05),且A组>B组>C组>D组。4组术后1、3、6个月肩关节Constant-Murley评分比较,差异有统计学意义(P<0.05),且C组>B组>A组,D组>B组>A组;但C组与D组各时间点肩关节Constant-Murley评分比较,差异无统计学意义(P>0.05);A、B、C、D 4组术后并发症发生率分别为15.00%、5.00%、7.50%、10.00%,组间比较,差异无统计学意义(P>0.05)。结论:2~3枚内侧柱支撑螺钉对行切开复位锁定钢板固定治疗肱骨近端骨折的生物力学性能更好,可一定程度上减少肱骨头高度丢失、促进肩关节功能恢复。
Objective:To explore the biomechanical effects of medial column support screw quantity in the open reduction and locking plate fixation for proximal humeral fractures and the clinical recovery of patients.Methods:A total of 40 artificial right humeri were made into surgical neck fracture models,and were evenly divided into groups a,b,c and d,and they were given 0,1,2 and 3 medial column support screws respectively.The biomechanical testing machine was used for the axial compression,shear force and antitorque tests.In addition,160 patients with proximal humeral fractures treated with open reduction and locking plate fixation were selected between January 2016 and June 2021,and were divided into group A,group B,group C and group D by the random envelope method,with 40 cases in each group.The number of medial support screw placement during surgery were 0,1,2 and 3 respectively.At 6 months of follow-up after surgery,the fracture healing time and loss value of humeral head height,functional recovery at different time points after surgery(shoulder joint Constant-Murley score)and occurrence of complications were compared among the four groups.Results:There were statistically significant differences in the maximum load and compressive stiffness of axial compression test,maximum load and compressive stiffness of shear force test and maximum torsion and antitorque stiffness of antitorque test among the four groups(P<0.05),and the above indicators were shown as group d>group c>group b>group a.There was no statistical significance in the fracture healing time among the four groups(P>0.05),but there was a statistical difference in the loss value of humeral head height(P<0.05),and it was shown as group A>group B>group C>group D.At 1 month,3 months and 6 months after surgery,there was a statistical significance in the shoulder joint Constant-Murley score among the four groups(P<0.05),and the score showed group C>group B>group A,and group D>group B>group A.But the difference in shoulder joint Constant-Murley score was not statis
作者
丁广江
张腾
李培坤
杨娜
江起庭
DING Guangjiang;ZHANG Teng;LI Peikun;YANG Na;JIANG Qiting(The People’s Hospital of Jiawang District of Xuzhou,Xuzhou 221011,Jiangsu,China;Orthopedic Center of Nanjing Jiangbei Hospital,Nanjing 210000,Jiangsu,China)
出处
《中国药物滥用防治杂志》
CAS
2022年第3期379-384,共6页
Chinese Journal of Drug Abuse Prevention and Treatment
关键词
肱骨近端骨折
锁定钢板固定
内侧柱支撑
螺钉数目
生物力学
功能恢复
Proximal humeral fractures
Locking plate fixation
Medial column support
Screw quantity
Biomechanics
Functional recovery
