中华肩肘外科电子杂志
中華肩肘外科電子雜誌
중화견주외과전자잡지
Chinese Journal of Shoulder and Elbow (Electronic Edition)
2015年
3期
160-163
,共4页
栗剑%张光武%张昆%吕鹏飞%薛涛
慄劍%張光武%張昆%呂鵬飛%薛濤
률검%장광무%장곤%려붕비%설도
肱骨骨折%髓内钉%钢板%内固定
肱骨骨摺%髓內釘%鋼闆%內固定
굉골골절%수내정%강판%내고정
Humeral fractures%Intramedullary nailing%Plating%Internal fixation
目的:回顾性研究肱骨干骨折采用钢板内固定和顺行髓内钉固定后的肩关节症状、功能和运动范围。方法回顾性分析19例钢板和20例顺行髓内钉内固定对肩关节功能的影响。随访肩关节 HSS、JOA、VAS 评分,肩关节运动范围。钢板组平均随访7.3年(1~11年);髓内钉组平均随访6年(1~10年)。结果 HSS 评分优良率:钢板组84.2%,髓内钉组65%;JOA 评分优良率:钢板组78.9%,髓内钉组60%;VAS 评分:钢板组1.78分,髓内钉组2.3分;肩关节运动范围:钢板组在前屈、外展、外旋运动方面优于髓内钉组。在肩关节评分、肩关节疼痛和运动范围方面,钢板组和髓内钉组间差异无统计学意义。结论两种内固定技术治疗后大部分肩关节功能可恢复到正常状态。顺行髓内钉固定只要提高手术操作技巧,防止医源性损伤,就能明显减少肩关节损伤。
目的:迴顧性研究肱骨榦骨摺採用鋼闆內固定和順行髓內釘固定後的肩關節癥狀、功能和運動範圍。方法迴顧性分析19例鋼闆和20例順行髓內釘內固定對肩關節功能的影響。隨訪肩關節 HSS、JOA、VAS 評分,肩關節運動範圍。鋼闆組平均隨訪7.3年(1~11年);髓內釘組平均隨訪6年(1~10年)。結果 HSS 評分優良率:鋼闆組84.2%,髓內釘組65%;JOA 評分優良率:鋼闆組78.9%,髓內釘組60%;VAS 評分:鋼闆組1.78分,髓內釘組2.3分;肩關節運動範圍:鋼闆組在前屈、外展、外鏇運動方麵優于髓內釘組。在肩關節評分、肩關節疼痛和運動範圍方麵,鋼闆組和髓內釘組間差異無統計學意義。結論兩種內固定技術治療後大部分肩關節功能可恢複到正常狀態。順行髓內釘固定隻要提高手術操作技巧,防止醫源性損傷,就能明顯減少肩關節損傷。
목적:회고성연구굉골간골절채용강판내고정화순행수내정고정후적견관절증상、공능화운동범위。방법회고성분석19례강판화20례순행수내정내고정대견관절공능적영향。수방견관절 HSS、JOA、VAS 평분,견관절운동범위。강판조평균수방7.3년(1~11년);수내정조평균수방6년(1~10년)。결과 HSS 평분우량솔:강판조84.2%,수내정조65%;JOA 평분우량솔:강판조78.9%,수내정조60%;VAS 평분:강판조1.78분,수내정조2.3분;견관절운동범위:강판조재전굴、외전、외선운동방면우우수내정조。재견관절평분、견관절동통화운동범위방면,강판조화수내정조간차이무통계학의의。결론량충내고정기술치료후대부분견관절공능가회복도정상상태。순행수내정고정지요제고수술조작기교,방지의원성손상,취능명현감소견관절손상。
Background The humeral shaft fracture is a common injury among upper limbs fractures.There have been documents reporting that the humeral shaft fracture occupy 3% among all fractures.The common operation methods include plate fixation and intramedullary nail fixation. Most scholars think that plate fixation is the golden criteria for comparing all kinds of fixations.And whether the intramedullary nail fixation can affect the shoulder joints functions are still controversial. This thesis has retrospective analysis on 39 patients who performed humeral plate fixation and intramedullary nail fixation in our hospital from January 2001 to September 2012,aiming at studying the effects of shoulder joints functions performed by two internal fixations .Methods General data:39 patients,25 males and 14 females aging 21-75 years old with the average age 43.9 years old were selected as the study subjects.Injury reasons:21 cases were due to falling down,9 cases were due to traffic accident injury,3 cases were due to high falling accident injury,2 cases were due to machine injury,2 cases were due to exercise injury,1 case was due to violence injury,1 case was pathological fracture.According to the AO types,5 cases were with A1 type,6 cases were with A2 type,1 1 cases were with A3 type,1 1 cases were with B1 type,4 cases were with B2 type,2 cases were with C1 type.Open fracture:2 cases were with Gustilo I type,2 cases were with II type,1 case was with IIIa type.The average time from being injured to operation was 1.2 days.Operation methods:All patients were given brachial plexus anesthesia or general anesthesia.1 7 cases in the plate fixation group adopted the incision from anterolateral side,2 cases adopted posterior side.The materials of internal fixation were ordinary plate,dynamic compression plate (DCP)or locking compression plate (LCP).The plate will be fixed according to the AO type principles.At least 3 to 4 screws should be used to the distal and proximal fractures for fixation.The intramedullary nail fixation group selected the Hungary Sanatmetal interlocking intramedullary nails which have proximal radian 1 1-13 degrees in the main nail,and 3 lock holes in the proximal points,2 lock holes in the distal points can achieve the interlocking.They were inserted in direct motion ways.The intramedullary nails which were inserted into the anteroposterior position were tightly attached to the furrow of the inner side of greater tuberosity,and the ones that were inserted into the side position were located to the axle wire located in humeral shaft.Post-operative treatment:(1)Movement rehabilitation:post-operative neck wrist belt immobilization.After operation,the patients should not burden any weights,and keep doing the active and passive movements including clock pendulum movements,forward flexion,outstretch, adduction,internal rotation practice.If the X-ray film indicates the nonunion of fracture,the patients should not burden any weights.(2)Post-operation follow-up visit and evaluation criteria:All patients were followed up after operation.The items included:(1)X-ray check.(2)adopted HSS and JOA evaluation systems to evaluate the shoulder joints symptoms and functions.The shoulder joint pain evaluation system adopted visual assessment simulation (VAS).The movement range measurement adopted the angle tester.(3)Statistically treatment:Apply PASW Statistics 18.0 statistical software to statistical analysis.Adopted Mann-Whitney rank sum test to decide the movement ranges,HSS and JOA evaluation of the plate fixation group and the intramedullary nail fixation group,and judge whether the VAS evaluation exist differences.P < 0.05 regarded the difference have statistically significance.Results The patients in the plate fixation group were followed up from 1-1 1 year,with an average of 7.3 years.Patients in the intramedullary nail fixation group were followed up from 1-10 year,and the average was 6 years.39 cases got fracture union,and the average fracture union time was 13.1 weeks (8-24 weeks).The difference between the plate group and intramedullary nail fixation group have no statistically significance in the parameters of shoulder joint function evaluation,pain degree and movement ranges.Conclusion The injury reasons for shoulder joint dysfunction in humeral shaft fracture need to be further investigated.The operation skills for intramedullary nail fixation in direct motion should be enhanced.The patients should attach importance to the fracture functional rehabilitation in early phase,especially those patients above 50 years old.It is necessary to have randomly comparison of the two fixations in large samples.