锁定钢板治疗非骨质疏松性复杂肱骨近端骨折的中期临床及影像学随访研究

doi:10.3969/j.issn.1671-167X.2017.05.020

摘要/Abstract

摘要： 目的回顾性分析采用锁定钢板治疗非骨质疏松性三部分和四部分肱骨近端骨折的临床效果。方法回顾性评估锁定钢板治疗非骨质疏松性三部分和四部分肱骨近端骨折的临床效果,统计患肢的肩关节活动度、临床评分、视觉模拟评分(visual analogue scale,VAS)和影像学检查的结果。结果自2007年1月至2014年10月,采用锁定钢板共治疗107例新鲜非骨质疏松性三部分和四部分肱骨近端骨折,其中67例患者完成至少2年的随访,平均随访时间(43.9±23.3)个月(24~108个月)。在最终随访时,Constant评分平均为(87.1±11.7)分(51~100分),加州大学肩关节评分(the University of California at Los Angeles shoulder score, UCLA)平均为(30.5±3.9)分(18~35分),VAS疼痛评分为(1±2)分(0~7分);主动前屈上举为159.0°±19.3°(80°~180°),体侧外旋为36.8°±19.5°(0°~80°),体侧内旋为T11水平(T2~LS水平)。术后11例患者出现并发症,包括5例螺钉穿出(7.5%),9例肱骨头缺血坏死(13.4%)及5例创伤性骨性关节炎(7.5%),6例合并两种或两种以上并发症。三部分骨折和四部分骨折术后患者的肩关节活动度、临床评分和VAS疼痛评分差异无统计学意义。四部分骨折的术后并发症率及术后肱骨头缺血坏死概率显著高于三部分骨折。结论应用肱骨近端锁定钢板治疗非骨质疏松性三、四部分复杂肱骨近端骨折可得到满意的术后肩关节功能恢复,严格的适应证选择与精细的手术操作是取得手术成功的关键,骨折的复杂程度亦对术后结果产生影响,四部分骨折的并发症发生率以及术后肱骨头缺血坏死率高于三部分骨折。

关键词: 锁定钢板, 肱骨骨折, 近端, 治疗结果, 手术后并发症

Abstract: Objective: To describe long-term results of locking plate used for the treatment of non-osteoporotic fresh three- and four-part proximal humeral fractures with at least 2 years follow-up. Methods: The functional outcomes and the complications of non-osteoporotic three- and four-part fresh proximal humeral fractures treated with locking plate were assessed retrospectively. The active range of motion, the Constant score, the University of California at Los Angeles (UCLA) shoulder score, the visual analogue score (VAS) were employed to evaluate the postoperative shoulder function, and the radiographic images were taken to evaluate the neck-shaft angle of the proximal humeral and postoperative implant-related complications. Results: From January 2007 to October 2014, 107 consecutive fresh three- and four-part non-osteoporotic fresh proximal humeral fractures were treated with a locking plate in our department. Among them, 67 patients completed at least 2 years follow-up. The average follow-up time was (43.9±23.3) months (range: 24-108 months). The mean Constant score was 87.1±11.7 (range: 51-100), the mean UCLA score was 30.5±3.9 (range: 18-35), the mean VAS score was 1±2 (range: 0-7). The mean active forward flexion was 159.0°±19.3° (range: 80°-180°), the mean external rotation was 36.8°±19.5°(0°-80°) and the mean internal rotation was T11 level (T2-LS level). There were 11 patients who suffered from complications. Screw perforations were observed in 5 (7.5%) patients, avascular necrosis of the humeral head was observed in 9 (13.4%) patients and traumatic osteoarthritis was observed in 5 (7.5%) patients. Six patients showed two or more complications. There was no significant difference in outcomes when comparing the patients with three-part fractures (31 patients) with those with four-part fractures (36 patients). The rates of complications and avascular necrosis were significantly higher in the four-part fracture group than in the three-part fracture group. Conclusion: The locking plate is an effective method in treating three- and four-part non-osteoporotic fresh proximal humeral fractures. Strict surgical indication and precise surgical skill are the key points for successful treating non-osteoporotic fresh proximal humeral fractures. There is a higher rate of complications and avascular necrosis of the humeral head in the four-part fractures than in the three-part fractures.

Key words: Locking plate, Humeral fractures, proximal, Treatment outcome, Postoperative complications

中图分类号:

R683.41

李旭, 李奉龙, 鲁谊, 朱以明, 郭斯翊, 李屹钧, 姜春岩. 锁定钢板治疗非骨质疏松性复杂肱骨近端骨折的中期临床及影像学随访研究[J]. 北京大学学报(医学版), 2017, 49(5): 855-860.

LI Xu, LI Feng-long, LU Yi, ZHU Yi-ming, GUO Si-yi, LI Yi-jun, JIANG Chun-yan. Clinical study on locking plate for the treatment of non-osteoporotic complex proximal humeral fractures[J]. Journal of Peking University(Health Sciences), 2017, 49(5): 855-860.

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