摘要
目的通过与肱骨近端解剖钢板（APHP）和T形钢板进行比较，评价肱骨近端锁定钢板（LPHP）在治疗肱骨近端粉碎性骨折中的应用价值。方法对2008年8月至2010年9月收治的65例肱骨近端粉碎性骨折患者资料进行回顾性分析，男36例，女29例；年龄24～70岁，平均39岁。均为NeerⅢ、IV型骨折，根据内固定方式不同分为3组：LPHP组（36例）、APHP组（19例）和T形钢板组（10例）。骨折复位后断端如果有骨缺损，则植入白体骨。比较3组患者的术中出血量、手术时间、愈合时间、骨折愈合率、肩关节功能优良率及术后并发症发生情况等。结果LPHP组、APHP组、T形钢板组术中平均出血量分别为（156．6±42．3）mL、（175．2±41．2）mL、【191．7±39．6）mL，3组间两两比较差异有统计学意义（P〈0．05）；平均手术时间分别为（86．3±12．3）min、（96．1±13．6）min、（101．2±12．6）min，3组间两两比较差异有统计学意义（P〈0．05）。所有患者术后随访12～18个月，平均14．5个月、61例获得临床愈合，其中LPHP组36例，DCP组17例，T形钢板组8例，3组骨折愈合率两两比较差异均有统计学意义（P〈0．05）；平均愈合时间分别为（10．1±1．2）周、（12．3±1．4）周、（15．4±2．6）周，3组间两两比较差异均有统计学意义（P〈0．05）；有4例发生肱骨头坏死，其中APHP组2例．T形钢板组2例，3组肱骨头坏死发生率两两比较差异均有统计学意义（P〈0．05）；肩关节功能评定根据Neer评分标准：LPHP组优32例，良3例，差1例，优良率为97．2％；APHP组优10例，良2例，差5例，优良率为63．2％；T形钢板组良4例，差4例，优良率为40．0％，3组优良率两两比较差异均有统计学意义（P〈0．05）。结论与APHP和T形钢板比较，LPHP既可以牢固固定肱骨近端粉碎性骨折各个骨折块，又保护了肱骨头发骨折端的残留血供，骨折愈合快，术后恢复快，并发症少。
Objective To evaluate the efficacy of locking proximal humeral plate （LPHP） for the treatment of comminuted fractures of proximal humerus in comparison with anatomical proximal humeral plate （APHP） and T-shaped plate. Methods From August 2008 to September 2010, 65 patients with cornminuted fracture of proximal humerus of Neer types III-IV were treated in our department. They were 36 men and 29 women, with an average age of 39 years （from 24 to 70 years）. LPHP was used in 36 palients （group A）, APHP in 19 patients （group B） and T plate in 10 patients （group C）. All the operations were conducted through the deltoid-pectoral-gap, and autografts were transplanted in the cases of bone defects after reduction. Exercises were done I to 6 weeks postoperation to prevent shoulder anchylosis. The clinical outcomes were compared between the 3 methods, including fracture healing, Neer score and complications. Results All the patients were followed up from 12 to 18 months （14.5 months on average）. Fracture union was achieved in 36 cases in group A, in 17 cases in group B and in 8 cases in group C, with significant between-group differences （ P 〈 0. 05）. The mean healing time was 10. 1 ± 1.2 weeks in group A, 12. 3 ± 1.4 weeks in group B and 15.4 ±2.6 weeks in group C, with significant between-group differences （ P 〈 0. 05）. Humeral head necrosis occurred in 2 eases in group B and in 2 cases in group C, with a significant difference between group A and groups B and C （ P 〈 0. 05）. By Neer scoring system, the good to excellent rate of shoulder function was 97.2% in group A. 63.2% in group B and 40. 0% in group C, with significant between-group differences （ P 〈 0. 05） . Conclusion LPHP can be considered as the standard-therapy for eomminuted fractures of proximal humerus of Neer types III-IV, because it can firmly fixate the comminuted fractures of the proximal humerus, leading to fast fracture healing, good fimctional recovery, and limited complications.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第6期513-517,共5页
Chinese Journal of Orthopaedic Trauma
关键词
肩骨折
骨折
粉碎性
骨折固定术
内
骨板
Shoulder fractures
Fractures, comminuted
Fracture fixation, internal
Bone plates
