摘要
目的探讨同种异体腓骨移植锁定钢板固定治疗C2型肱骨近端骨折的临床疗效。方法回顾分析2011年1月-2012年8月，采用同种异体腓骨移植髓内支撑、锁定钢板固定治疗AO分型为C2型肱骨近端骨折且随访完整的16例患者临床资料。男5例，女11例；年龄55～70岁，平均64岁。致伤原因：跌伤12例，交通事故伤3例，运动伤1例。受伤至手术时间2～6d，平均4．5d。术后根据影像学资料评判骨折愈合情况，并测量颈干角和肱骨头高度；采用前臂、肩、手功能障碍评分（DASH）、简明健康调查量表（SF．36量表）、Neer评分评判肩关节功能。结果术后切口均I期愈合，无神经、血管损伤等并发症。16例均获随访，随访时间12～24个月，平均18个月。骨折均愈合，愈合时间18～24周，平均20周。无大、小结节再移位，肱骨头移位或坏死发生，无明显排斥反应，无螺钉松动、拔出、切割等并发症。术中颈干角为130．5～138．0°，平均134．0°；末次随访时为126．6～136．9°，平均132．50，较术中略有丢失。术后12个月，肱骨头高度丢失1．8～4．6mm，平均2．0mm；被动前屈130～1600，平均1480；主动前屈120～145°，平均136°；外旋30～65°，平均56°；内旋15～25°，平均19°。DASH评分为2～53分，平均12分；SF-36量表评分为50～95分，平均89分。肩关节功能根据Neer评分评定：优10例，良4例，可1例，差1例：优良率87．5％。结论同种异体腓骨移植联合锁定钢板固定能够有效复位和固定C2型肱骨近端骨折块，改善临床评分，降低内固定失败（如螺钉松动、切割）的风险。
Objective To investigate the clinical results of locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation. Methods Between January 2011 and August 2012, 16 patients with proximal humeral fractures （AO type C2） were treated by locking-plate with an intramedullary fibular allograft. The clinical data were retrospectively analysed. There were 5 males and 11 females with an average age of 64 years （range, 55-70 years）. The injury causes were falling injury in 12 cases, traffic-accident injury in 3 cases, and sports injury in 1 case. The duration between injury and operation ranged from 2 to 6 days （mean, 4.5 days）. The imaging data were used to judge the fracture healing, and to measure the neck-shaft angle and the height of humeral head; the disability of arm, shoulder, and hand （DASH） score, short-form 36 health survey scale （SF-36）, and Neer score were used to evaluate the function of the shoulder after surgery. Results Primary healing of incision was obtained in all patients; no complication of vascular and nerve injury occurred. Sixteen cases were followed up 12-24 months （mean, 18 months）. All fractures healed at 18-24 weeks （mean, 20 weeks）. No complication occurred as follows： re-displacement, necrosis, rejection reaction, and loosening or extraction of screws. At last follow-up, the neck-shaft angle was 126.6-136.9° （mean, 132.5°）, showing a little lost when compared with intraoperative angle （130.5-138.0°, 134.0° on average）. At 12 months after surgery, the height loss of humeral head was 1.8-4.6 mm （mean, 2.0 mm）; the passive anteflexion of the shoulder was 130-160° （mean, 148°）; the active anteflexion was 120-145°（mean, 136°）; the external rotation was 30-65° （mean, 56°）; the internal rotation was 15-25° （mean, 19°）. And the DASH score was 2-53 （mean, 12）; the SF-36 score was 50-95 （mean, 89）. According to Neer score for shoulder function, the results were excellent in 10 cases, good in 4 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 87.5%. Conclusion Locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation has satisfactory clinical results because of stable fixation, high clinical outcome scores, and low internal fixation failure.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第2期201-204,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肱骨近端骨折
锁定钢板
同种异体腓骨移植
髓内支撑
Proximal humeral fracture
Locking-plate
Fibular allograft
Intramedullary support
