目的探讨锁定钢板结合异体腓骨髓内支撑(locking compression plate with fibular allograft,F-LCP)治疗老年肱骨近端粉碎性骨折的中远期临床疗效及并发症。方法回顾性分析2013年1月-2015年12月我院104例老年肱骨近端三部分或四部分骨...目的探讨锁定钢板结合异体腓骨髓内支撑(locking compression plate with fibular allograft,F-LCP)治疗老年肱骨近端粉碎性骨折的中远期临床疗效及并发症。方法回顾性分析2013年1月-2015年12月我院104例老年肱骨近端三部分或四部分骨折患者资料,其中采用单纯锁定钢板内固定术(locking compression plate,LCP)治疗61例为Ⅰ组,锁定钢板结合异体腓骨髓内支撑治疗43例为Ⅱ组。评估术后随访1年时两组临床疗效,包括Constant-Murley评分(CMS)、肩-手功能障碍评分(disabilities of the arm,shoulder and hand score,DASH)、加利福尼亚大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节评分、肩关节活动范围评分(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)及术后影像学资料。结果两组基线资料的差异均无统计学意义(P均> 0.05)。术后骨折愈合时间,Ⅰ组(4.72±0.93)个月,Ⅱ组(4.77±0.90)个月,差异无统计学意义(P=0.801)。术后1年复查X线片,Ⅰ组肱骨头高度丢失(4.48±2.06) mm,显著高于Ⅱ组的(2.19±1.58) mm (P <0.001);颈干角差值大于Ⅱ组[(8.56±4.96)°vs (3.17±2.93)°,P <0.001];Ⅰ组11例发生肱骨头内翻畸形(颈干角<110°),8例发生螺钉切出,2例发生肱骨头坏死,并发症发生率为34.43%;Ⅱ组2例发生肱骨头内翻畸形,1例发生螺钉切出,2例发生肱骨头坏死,并发症发生率为11.63%,差异有统计学意义(P=0.008)。术后1年Ⅱ组各项功能评估均优于Ⅰ组:CMS[(75.42±4.77) vs (62.89±8.25)],DASH[(16.09±2.87) vs (31.15±9.55)],UCLA肩关节评分[(31.40±1.50) vs(28.97±1.61)],ROM[(25.77±3.84) vs(18.34±4.43)](P均<0.05);两组VAS评分差异无统计学意义[Ⅰ组(1.57±0.62) vsⅡ组(1.42±0.55),P=0.189)。结论本研究中锁定钢板结合异体腓骨髓内支撑治疗老年肱骨近端骨折效果优于单纯锁定钢板内固定,功能结局更优,并发症发生率低。展开更多
The majority of proximal humerus fractures are lowenergy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered rend...The majority of proximal humerus fractures are lowenergy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered renders objective classification of prognostic value challenging. Non-operative management has been associated with good functional outcomes in stable, minimally displaced and certain types of displaced fractures.Absolute indications for surgery are infrequent and comprise compound, pathological, multi-fragmentary head-splitting fractures and fracture dislocations, as well as those associated with neurovascular injury. A constantly expanding range of reconstructive and replacement options however has been extending the indications for surgical management of complex proximal humerus fractures. As a result, management decisions are becoming increasingly complicated, in an attempt to provide the best possible treatment for each indi-vidual patient, that will successfully address their specific fracture configuration, comorbidities and functional expectations. Our aim was to review the management options available for the full range of proximal humerus fractures in adults, along with their specific advantages, disadvantages and outcomes.展开更多
文摘目的探讨锁定钢板结合异体腓骨髓内支撑(locking compression plate with fibular allograft,F-LCP)治疗老年肱骨近端粉碎性骨折的中远期临床疗效及并发症。方法回顾性分析2013年1月-2015年12月我院104例老年肱骨近端三部分或四部分骨折患者资料,其中采用单纯锁定钢板内固定术(locking compression plate,LCP)治疗61例为Ⅰ组,锁定钢板结合异体腓骨髓内支撑治疗43例为Ⅱ组。评估术后随访1年时两组临床疗效,包括Constant-Murley评分(CMS)、肩-手功能障碍评分(disabilities of the arm,shoulder and hand score,DASH)、加利福尼亚大学洛杉矶分校(University of California Los Angeles,UCLA)肩关节评分、肩关节活动范围评分(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)及术后影像学资料。结果两组基线资料的差异均无统计学意义(P均> 0.05)。术后骨折愈合时间,Ⅰ组(4.72±0.93)个月,Ⅱ组(4.77±0.90)个月,差异无统计学意义(P=0.801)。术后1年复查X线片,Ⅰ组肱骨头高度丢失(4.48±2.06) mm,显著高于Ⅱ组的(2.19±1.58) mm (P <0.001);颈干角差值大于Ⅱ组[(8.56±4.96)°vs (3.17±2.93)°,P <0.001];Ⅰ组11例发生肱骨头内翻畸形(颈干角<110°),8例发生螺钉切出,2例发生肱骨头坏死,并发症发生率为34.43%;Ⅱ组2例发生肱骨头内翻畸形,1例发生螺钉切出,2例发生肱骨头坏死,并发症发生率为11.63%,差异有统计学意义(P=0.008)。术后1年Ⅱ组各项功能评估均优于Ⅰ组:CMS[(75.42±4.77) vs (62.89±8.25)],DASH[(16.09±2.87) vs (31.15±9.55)],UCLA肩关节评分[(31.40±1.50) vs(28.97±1.61)],ROM[(25.77±3.84) vs(18.34±4.43)](P均<0.05);两组VAS评分差异无统计学意义[Ⅰ组(1.57±0.62) vsⅡ组(1.42±0.55),P=0.189)。结论本研究中锁定钢板结合异体腓骨髓内支撑治疗老年肱骨近端骨折效果优于单纯锁定钢板内固定,功能结局更优,并发症发生率低。
文摘The majority of proximal humerus fractures are lowenergy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered renders objective classification of prognostic value challenging. Non-operative management has been associated with good functional outcomes in stable, minimally displaced and certain types of displaced fractures.Absolute indications for surgery are infrequent and comprise compound, pathological, multi-fragmentary head-splitting fractures and fracture dislocations, as well as those associated with neurovascular injury. A constantly expanding range of reconstructive and replacement options however has been extending the indications for surgical management of complex proximal humerus fractures. As a result, management decisions are becoming increasingly complicated, in an attempt to provide the best possible treatment for each indi-vidual patient, that will successfully address their specific fracture configuration, comorbidities and functional expectations. Our aim was to review the management options available for the full range of proximal humerus fractures in adults, along with their specific advantages, disadvantages and outcomes.
