摘要
[目的]探讨内侧支撑在锁定钢板治疗肱骨近端骨折中维持骨折复位的应用。[方法]2008年7月～2012年3月采用锁定钢板治疗肱骨近端骨折，最终临床资料完整者41例，男16例，女25例，年龄38～89岁，平均69岁，随访时间12-24个月，平均16个月，每次摄x线片都测量相对钢板的“肱骨头高度”，根据术后x线片视肱骨近端内侧柱支撑重建情况，分为有内侧支撑组（A组）23例、没有内侧支撑组（B组）18例。在术后1周内（T1）、术后3个月（T2）、术后1年（T3）摄X线片测量“肱骨头高度”，并计算在术后至术后3个月（T1～T2）、术后3个月～术后1年（T2～T3）期间高度变化。在T2、T3时期用Neer疗效评定标准对术后肩关节功能进行评定。[结果]A、B组术后并发症例数卡方检验差异有统计学意义（X2=4．12，P〈0．05）。在T1-T2：期间A组“肱骨头高度”丢失程度少于B组，两组间差异有统计学意义（t=-30．33，P〈0．01）；在T2-T3 期间两组“肱骨头高度”丢失程度差异没有统计学意义（t=-1．84，P〉0．05）。在T2时期、T3时期A组Neer百分法功能评定值（分）均高于B组，两组间差异有统计学意义（P〈0．01）。[结论]锁定钢板治疗肱骨近端骨折中有内侧支撑者，能更好维持骨折复位，减少术后并发症。
[Objective] To investigate the importance of medial support in locked plating of proximal humerus fractures. [ Method ] Between July 2008 and March 2012,41 patients （16 men and 25 women, mean age, 69 years [ 38 - 89 years ] ）with coherent unstable proximal humeral fractures were treated with locking plate fixation, with a mean follow - up period of 16 months（ 12 -24 months）. The humeral head height relative to the plate was measured from the radiographs of each patient. One independent examiner evaluated postoperative radiographs of the shoulder to divide the patients into a group who underwent ade- quate medial column reconstruction （ group A, 23 cases） and those who underwent inadequate medial column reconstruction （group B, 18 cases）. The patients were evaluated using outpatient physical examination data, radiographs,humeral head height values, and 1 - week （ T1 ）, 3 - month （ T2 ） , and 1 - year （ T3 ） postoperative Neer scores. [ Result ] The incidence rate of locking plate complications was significantly different（x2 = 4. 12, P 〈 0.05 ） between group A and group B. The loss of humeral head height over T1 to T2 was greater in group B than in group A ,with a statistically significant difference（ t = - 30. 33 ,P 〈 0.01 ）. However, over T2 to T3 , this loss was not significantly different （ t = - 1.84, P 〉 0.05 ）. According to the Neer scoring system, the scores of group A were significantly higher than those of group B at T2 and T3 （P 〈 0.01 ）. [ Conclusion] Mechanical support of the medial region allows for better maintenance of reduction, thereby reducing the incidence of locking plate complications in proximal humerus fractures.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2014年第4期299-303,共5页
Orthopedic Journal of China
关键词
肱骨近端骨折
锁定钢板
骨折内固定
proximal humeral fractures, locking plate, fracture internal fixation
