肱骨近端复杂骨折内固定的临床应用研究

Clinical research on the internal fixations in the treatment of complex proximal humeral fracture

目的探讨肱骨近端复杂骨折的手术方式。方法2002年1月～2007年1月对70例肱骨近端三部分骨折患者分为4组。A组20例,行交叉克氏针加螺钉内固定;B组23例,行切开复位解剖钢板内固定;C组15例,行切开复位Ender氏针加张力带内固定;D组12例,行切开复位近端锁定钢板内固定。结果70例均获得随访,随访10～19个月,平均11.5个月。术后采用Neer评分方法评定疗效。A组20例中优3例,良11例,可4例,差2例,优良率70.0%;B组23例中优5例,良12例,可3例,优良率73.9%;C组15例中优7例,良5例,可2例,差1例优良率80.0%;D组12例中优5例,良5例,可1例,差1例,优良率83.3%。C、D组疗效明显优于A组和B组,差异有统计学意义(P<0.05);A组与B组及C组与D组疗效比较差异无统计学意义(P>0.05)。结论肱骨近端锁定钢板治疗肱骨近端复杂骨折,内固定力学强度大,稳定性好,临床疗效满意,优于其他内固定方法。而Ender氏针加张力带固定也较为牢固,稳定性较好,临床疗效较满意。

Objective To discuss the surgical treatment of complex proximal humeral fractures. Methods From January 2002 to January 2007, 70 patients with three-part proximal humeral fracture were divided into 4 groups. There were 20 patients in the group A who underwent internal fixation with crossing Kirschner wires combined with screws, 23 in the group B underwent open reduction and internal fixation with anatomical steel plates, 15 in the group C were treated by ender nails combined with tension bands, open reduction and internal fixation with locking proximal humerus plates were performed for the 12 patients in the group D. Results The seventy cases were followed up for an average of 11.5 months （ 10 - 19 months）. The function of the shoulder joint was evaluated with Neer scoring. In group A, 3 were excel- lent, 11 were good and 6 were fair, the excellent and good rates were 70.0% , in group B, 5 were excel- lent, 12 were good, 3 were fair, the excellent and good rates were 73.9%. In group C, 7 were excellent, 5 were good, 2 were fair and 1 was poor, the excellent and good rates were 80.0%. In group D, 5 were excellent, 5 were good, 1 was fair and 1 was poor, the excellent and good rates were 83.3 %. The clinical efficacy of group C and D was much better than that of A and B （ P 〈 0. 05 ）. There was no significant difference between group C and D （ P 〉 0. 05 ） or between A and B. Conclusions LPHP will perform better stabilization and clinical efficacy than that of other internal Fixations. The ender nail combined with tension band also can provide good stabilization and clinical efficacy.