摘要
目的探讨锁定钢板治疗Neer三部分及四部分肱骨近端骨折的疗效。方法回顾分析2008年7月-2011年5月,采用切开复位、锁定钢板内固定治疗并获12个月以上随访的77例Neer三部分及四部分肱骨近端骨折患者的临床资料。男39例,女38例;年龄18～81岁,平均54.2岁。致伤原因:跌伤47例,交通事故伤16例,高处坠落伤4例,运动伤5例,其他原因5例。受伤至手术时间2～16 d,平均4.5 d。骨折根据Neer分型标准:三部分骨折54例,四部分骨折23例。随访评估患者肩关节功能Constant评分、疼痛视觉模拟评分(VAS)及相关并发症。结果术后76例切口Ⅰ期愈合,1例Ⅱ期愈合。患者均获随访,随访时间12～36个月,平均18.5个月。末次随访时,Constant评分为(71.1±11.9)分;获优18例,良24例,中25例,差10例,优良率为54.5%。VAS评分为(2.8±2.2)分。2例患者发生骨不连;余患者骨折均愈合,愈合时间2～6个月,平均3.2个月。术后25例患者发生并发症,发生率为32.5%;15例行二次手术,二次手术率为19.5%。结论对于Neer三部分及四部分肱骨近端骨折应争取解剖复位、稳定固定、减少肱骨头血供破坏,以获得良好疗效。
Objective To evaluate the effectiveness of locking plates for Neer 3- and 4-part proximal humerus fractures. Methods A retrospective analysis was made on the clinical data of 77 patients with 3- or 4-part proximal humerus fractures, who underwent open reduction and internal fixation of locking plates and were followed up more than 12 months between luly 2008 and May 2011. There were 39 males and 38 females with an average age of 54.2 years （range, 18-81 years）. Fractures were caused by falling in 47 cases, by traffic accident in 16 cases, by falling from height in 4 cases, by sporting in 5 cases, and by other reasons in 5 cases. The time between injury and operation was 2-16 days （mean, 4.5 days）. According to Neer classification, there were 54 cases of 3-part fracture and 23 cases of 4-part fracture. The Constant scores, visual analogue score （VAS）, and the complications were evaluated during follow-up. Results After operation, healing of incisions by first intention was obtained in 76 cases and healing by second intention in 1 case. All patients were followed up 12-36 months （mean, 18.5 months）. At last follow-up, the Constant score was 71.1 _＋ 11.9; the results were excellent in 18 cases, good in 24 cases, fair in 25 cases, and poor in 10 cases with an excellent and good rate of 54.5%. The VAS score was 2.8 ＋ 2.2. Bone nonunion occurred in 2 cases; the other patients had bone union within 2-6 months （mean, 3.2 months）. The complications occurred in 25 cases （32.5%）. Revision surgery was performed in 15 patients （19.5%）. humerus fractures remains challenging. Anatomic reduction, stable may lead to a satisfactory outcome. Conclusion The treatment of Neer 3- and 4-part proximal fixation, and reduced humeral head blood supply disruption
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2012年第12期1469-1472,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
上海交通大学"医工(理)交叉基金"资助项目(YG2009MS31)~~
关键词
肱骨近端骨折
锁定钢板
内固定
Proximal humerus fracture Locking plate Internal fixation
