中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2012年
5期
412-417
,共6页
孙辽军%黄高%郭晓山%余贤斌%胡炜%陈华
孫遼軍%黃高%郭曉山%餘賢斌%鬍煒%陳華
손료군%황고%곽효산%여현빈%호위%진화
肩骨折%关节成形术,置换%微创钢板接骨术
肩骨摺%關節成形術,置換%微創鋼闆接骨術
견골절%관절성형술,치환%미창강판접골술
Shoulder fractures%Arthroplasty,replacement%Minimally invasive plate osteosynthesis
目的 通过前瞻性研究探讨微创钢板接骨术(minimally invasive plate osteoynthesis,MIPO)与肱骨头置换治疗老年Neer四部分骨折的疗效. 方法 胸大肌三角肌间隙人路,采用锁定钢板结合MIPO技术治疗老年新鲜Neer四部分骨折28例(A组),行人工肱骨头置换治疗相同骨折27例(B组),应用Neer评分、Constant - Murley评分以及简明肩关节问卷(simple shoulder test,SST)等评估治疗结果. 结果 A组平均随访32.1个月,2例螺钉进入关节间隙,1例大结节向后上移位,肱骨头缺血性坏死1例.平均疼痛视觉模拟评分(visual analog scale,VAS)、平均肩关节Neer评分和平均Constant - Murley评分分别为2.2分、88.6分和86.5分.SST中回答“是”的问题平均为9.0个.B组平均随访34.6个月,4例出现肩关节脱位或者半脱位,8例出现大结节移位或过度复位问题.平均VAS评分、平均Neer评分和平均Constant - Murley评分分别为2.4分、78.9分和77.3分.SST问卷中回答“是”的问题平均为8.0个.两组VAS评分比较差异无统计学意义,而并发症、Neer评分、Constant - Murley评分及SST评分结果比较差异有统计学意义,A组优于B组. 结论 对于大多数老年Neer四部分骨折,在严格掌握手术适应证及手术技巧的前提下,应用MIPO可以获得满意的结果,而人工肱骨头置换术仍存在较多尚未解决的问题,选择时需慎重.
目的 通過前瞻性研究探討微創鋼闆接骨術(minimally invasive plate osteoynthesis,MIPO)與肱骨頭置換治療老年Neer四部分骨摺的療效. 方法 胸大肌三角肌間隙人路,採用鎖定鋼闆結閤MIPO技術治療老年新鮮Neer四部分骨摺28例(A組),行人工肱骨頭置換治療相同骨摺27例(B組),應用Neer評分、Constant - Murley評分以及簡明肩關節問捲(simple shoulder test,SST)等評估治療結果. 結果 A組平均隨訪32.1箇月,2例螺釘進入關節間隙,1例大結節嚮後上移位,肱骨頭缺血性壞死1例.平均疼痛視覺模擬評分(visual analog scale,VAS)、平均肩關節Neer評分和平均Constant - Murley評分分彆為2.2分、88.6分和86.5分.SST中迴答“是”的問題平均為9.0箇.B組平均隨訪34.6箇月,4例齣現肩關節脫位或者半脫位,8例齣現大結節移位或過度複位問題.平均VAS評分、平均Neer評分和平均Constant - Murley評分分彆為2.4分、78.9分和77.3分.SST問捲中迴答“是”的問題平均為8.0箇.兩組VAS評分比較差異無統計學意義,而併髮癥、Neer評分、Constant - Murley評分及SST評分結果比較差異有統計學意義,A組優于B組. 結論 對于大多數老年Neer四部分骨摺,在嚴格掌握手術適應證及手術技巧的前提下,應用MIPO可以穫得滿意的結果,而人工肱骨頭置換術仍存在較多尚未解決的問題,選擇時需慎重.
목적 통과전첨성연구탐토미창강판접골술(minimally invasive plate osteoynthesis,MIPO)여굉골두치환치료노년Neer사부분골절적료효. 방법 흉대기삼각기간극인로,채용쇄정강판결합MIPO기술치료노년신선Neer사부분골절28례(A조),행인공굉골두치환치료상동골절27례(B조),응용Neer평분、Constant - Murley평분이급간명견관절문권(simple shoulder test,SST)등평고치료결과. 결과 A조평균수방32.1개월,2례라정진입관절간극,1례대결절향후상이위,굉골두결혈성배사1례.평균동통시각모의평분(visual analog scale,VAS)、평균견관절Neer평분화평균Constant - Murley평분분별위2.2분、88.6분화86.5분.SST중회답“시”적문제평균위9.0개.B조평균수방34.6개월,4례출현견관절탈위혹자반탈위,8례출현대결절이위혹과도복위문제.평균VAS평분、평균Neer평분화평균Constant - Murley평분분별위2.4분、78.9분화77.3분.SST문권중회답“시”적문제평균위8.0개.량조VAS평분비교차이무통계학의의,이병발증、Neer평분、Constant - Murley평분급SST평분결과비교차이유통계학의의,A조우우B조. 결론 대우대다수노년Neer사부분골절,재엄격장악수술괄응증급수술기교적전제하,응용MIPO가이획득만의적결과,이인공굉골두치환술잉존재교다상미해결적문제,선택시수신중.
Objective To identify the curative effect of minimally invasive plate osteosynthesis (MIPO) and humeral head replacement in treatment of elderly patients with Neer four-part fractures.Methods Using the deltoid pectoral approach,28 patients with fresh Neer four-part fractures were treated by the locking plate combined with MIPO (Group A) and 27 by the humeral head replacement (Group B).Neer score,Constant-Murley score and simple shoulder test (SST) questionnaire were adopted for assessing the treatment outcome. Results Group A was followed up for mean 32.1 months,which showed screws protruding into the joint space in two patients,tuberosity upward and backward displacement in one and femoral head ischemic necrosis in one.The mean visual analog scale (VAS) score,the mean Neer score and the mean Constant-Murley score were 2.2 points,88.6 points and 86.5 points respectively.There were average 9.0 answers for “yes” in the SST questionnaire.Group B were followed up for mean 34.6 months,which showed shoulder dislocation or subluxation in four patients,tuberosity displacement or excessive reduction in eight.The mean VAS score,the mean Neer score and the mean Constant-Murley score were 2.4 points,78.9 points and 77.3 points respectively.The mean number of answer for “yes” in SST questionnaire was 8.0 questions.There showed no statistical difference in VAS score between the two groups.While statistical difference was found in complications,Neer score,Constant-Murley score and SST score between two groups,with Group A superior to Group B. Conclusions For most elderly patients with Neer four-part fractures,MIPO has satisfactory results under strict control of surgical indications and technical tips.The humeral head replacement surgery still has many unresolved problems and needs careful consideration.