中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2014年
1期
43-46
,共4页
肱骨%肩骨折%骨折固定术,内%骨板
肱骨%肩骨摺%骨摺固定術,內%骨闆
굉골%견골절%골절고정술,내%골판
Humerus%Shoulder fractures%Fracture fixation,internal%Bone plates
目的 探讨软骨下骨立体支撑型(S3)肱骨近端锁定钢板治疗骨质疏松型肱骨近端骨折的技术要点及疗效.方法 2010年7月至201 1年7月共收治21例骨质疏松型肱骨近端骨折患者,男12例,女9例;年龄58 ～80岁(平均66.0岁).骨折根据Neer分型系统分型:三部分骨折13例,四部分骨折8例.合并肩关节脱位2例.常规行肩关节CT平扫及三维重建以明确骨折类型及受累情况,于伤后2～7d(平均4.0d)行切开复位S3肱骨近端锁定钢板内固定.术后定期复查X线片,记录相关并发症,并采用改良Constant-Murley评分、疼痛视觉模拟评分(VAS)评定疗效. 结果 18例患者术后获12 ～24个月(平均18.0个月)随访.骨折愈合时间为10 ～14周(平均12.0周).末次随访时改良Constant-Murley评分为62～ 96分(平均80.2分),VAS评分为0～6分(平均1.5分).2例四部分骨折患者分别于术后10、13个月X线片示肱骨头缺血性坏死,伴中度疼痛,予保守治疗后症状缓解.未见伤口感染、内固定失败、内固定物撞击等并发症. 结论 采用S3肱骨近端锁定钢板治疗骨质疏松型肱骨近端骨折固定效果稳定,且可避免钢板引起的撞击,是一种安全、有效的治疗方法.
目的 探討軟骨下骨立體支撐型(S3)肱骨近耑鎖定鋼闆治療骨質疏鬆型肱骨近耑骨摺的技術要點及療效.方法 2010年7月至201 1年7月共收治21例骨質疏鬆型肱骨近耑骨摺患者,男12例,女9例;年齡58 ～80歲(平均66.0歲).骨摺根據Neer分型繫統分型:三部分骨摺13例,四部分骨摺8例.閤併肩關節脫位2例.常規行肩關節CT平掃及三維重建以明確骨摺類型及受纍情況,于傷後2～7d(平均4.0d)行切開複位S3肱骨近耑鎖定鋼闆內固定.術後定期複查X線片,記錄相關併髮癥,併採用改良Constant-Murley評分、疼痛視覺模擬評分(VAS)評定療效. 結果 18例患者術後穫12 ～24箇月(平均18.0箇月)隨訪.骨摺愈閤時間為10 ～14週(平均12.0週).末次隨訪時改良Constant-Murley評分為62～ 96分(平均80.2分),VAS評分為0～6分(平均1.5分).2例四部分骨摺患者分彆于術後10、13箇月X線片示肱骨頭缺血性壞死,伴中度疼痛,予保守治療後癥狀緩解.未見傷口感染、內固定失敗、內固定物撞擊等併髮癥. 結論 採用S3肱骨近耑鎖定鋼闆治療骨質疏鬆型肱骨近耑骨摺固定效果穩定,且可避免鋼闆引起的撞擊,是一種安全、有效的治療方法.
목적 탐토연골하골입체지탱형(S3)굉골근단쇄정강판치료골질소송형굉골근단골절적기술요점급료효.방법 2010년7월지201 1년7월공수치21례골질소송형굉골근단골절환자,남12례,녀9례;년령58 ～80세(평균66.0세).골절근거Neer분형계통분형:삼부분골절13례,사부분골절8례.합병견관절탈위2례.상규행견관절CT평소급삼유중건이명학골절류형급수루정황,우상후2～7d(평균4.0d)행절개복위S3굉골근단쇄정강판내고정.술후정기복사X선편,기록상관병발증,병채용개량Constant-Murley평분、동통시각모의평분(VAS)평정료효. 결과 18례환자술후획12 ～24개월(평균18.0개월)수방.골절유합시간위10 ～14주(평균12.0주).말차수방시개량Constant-Murley평분위62～ 96분(평균80.2분),VAS평분위0～6분(평균1.5분).2례사부분골절환자분별우술후10、13개월X선편시굉골두결혈성배사,반중도동통,여보수치료후증상완해.미견상구감염、내고정실패、내고정물당격등병발증. 결론 채용S3굉골근단쇄정강판치료골질소송형굉골근단골절고정효과은정,차가피면강판인기적당격,시일충안전、유효적치료방법.
Objective To evaluate the surgical techniques and clinical outcomes of treating osteoporotic fracture of proximal humerus with Spatial Subchondral Support (S3) locking plate of proximal humerus.Methods From July 2010 to July 2011,21 patients with osteoporotic fracture of proximal humerus,12 males and 9 females,were treated in our department.They were 66.0 years old on average (from 58 to 80 years old).According to the Neer classification system,13 cases were 3-part fractures,8 4-part fractures,and 2 combined with shoulder dislocation.All cases were evaluated carefully with routine CT scans pre-operatively to define the type of fracture and the involvement of articular surface.Open reduction and internal fixation with S3 locking plate of proximal humerus was performed 2 to 7 days after injury (average,4.0 days).Regular X-ray follow-ups were taken and complications recorded as well.Overall function evaluation was carried out according to the modified Constant-Murley score system (CMS) and visual analogue scale (VAS).Results The 18 cases were followed up for a mean duration of 18.0 months (from 12 to 24 months).No complications of wound infection,implant failure or impingement were observed during the follow-ups.Bone union was achieved after an average of 12.0 weeks (from 10 to 14 weeks).On average,the Modified CMS score was 80.2 and the VAS score 1.5.At the post-operative 10th and 13th months,X-ray manifested avascular necrosis of the humeral head respectively in 2 cases of 4-part fractures,who suffered from moderate pain which was relieved after conservative treatment.Conclusion Fixation with S3 locking plate of proximal humerus is a safe and effective treatment of osteoporotic fracture of proximal humerus,because it is rigid and avoids plate-related impingement.
