撬拨复位内侧支撑植骨锁定钢板治疗肱骨近端粉碎性骨折

Leverage reduction and medial bone graft support in locking plate fixation of proximal humeral fractures

[目的]评估撬拨复位内侧支撑植骨锁定钢板治疗肱骨近端骨折疗效。[方法]对2008年8月～2010年8月本院73例[平均(56.4±8.7)岁]肱骨近端粉碎性骨折患者,随机分为两组,A组37例,切开复位后仅以锁定钢板固定,B组36例行内侧支撑植骨、骨折撬拨复位、锁定钢板固定。应用统计学方法评价两组术后的影像学指标和肩关节功能。[结果]术后随访8～18个月,平均12.4个月,所有骨折均愈合,平均愈合时间8.7个月,愈合后行内固定取出术。A组和B组中分别发生内固定失效6例和1例,差异有统计学意义(P<0.05),所有内固定失效均出现在术后3个月内。2组分别发生肱骨头内翻8例和1例,有明显统计学意义(P<0.05),丢失角度差异有统计学意义(P<0.05)。根据Constant肩关节评分标准评定:A组和B组的优良率分别为63%和89%,2组的评分差异有统计学意义(P<0.05)。[结论]锁定钢板在治疗肱骨近端骨折中可获得满意的疗效。在治疗肱骨近端骨折时,撬拨复位另以内侧植骨支撑在肱骨头内下方获得支撑,可有效地辅助复位并维持骨折复位,增加骨折固定的稳定性。

[ Objective ] To evaluate the effect of leverage reduction and medial hone graft support in locking plate fixation of proximal humeral fractures. [ Method I Seventy - three patients of proximal humeral fractures （ average age 56.4 ± 8.7 years old） were treated with open reduction locking plate fixation from August 2008 to August 2010 in our hospital. The patients were randomly divided into two groups, group A and group B. Thirty-seven patients were assigned to A group and treated with open re- duction and locking plate fixation, and 36 patients were assigned to group B and treated with medial bone graft support,leverage reduction and locking plate fixation. Statistical methods were applied to assess postoperative radiological parameters and shoulder function of both groups. [ Result] The mean follow - up period was 12.4 months （ range,8 - 18 months）. All fractures were u- nited at an average of 8.7 months. Fixation failures were observed in 6 cases of group A and in 1 cases of group B ,which were all found within 3 months postoperatively. The incidence of fixation failure was significantly different between two groups （ P 〈 0.05 ）. Eight cases in group A and 1 case in group B were observed varus displacement of humeral head, which was signifi- cantly different between two groups （ P 〈 0.05 ）, so was the greater loss of neck shaft angle in group A （ P 〈 0.05 ）. According to Constant shoulder score, the excellent and good result rate were 63% and 89% in group A and group B respectively, of which the difference was statistically significant. [ Conclusionl Locking plate fixation has been shown to lead to satisfactol＇y outcomes for the treatment of proximal humeral fractures. Leverage reduction and bone graft support under the medial inferior of the hu- meral head is suggested to aid reduction and maintain reduction of the proximal humeral fractures and to improve the stability of the fixation.