闭合复位经皮内固定治疗肱骨近端骨折的中期疗效

Intermediate outcomes following percutaneous fixation of proximal humeral fractures

[目的]考察肱骨近端骨折患者采用经皮复位固定治疗的中期临床效果。[方法]回顾分析2005～2008年因肱骨近端骨折接受经皮复位内固定治疗的39例患者资料,其中27例患者获得至少3年的临床及影像学随访,平均随访时间为60个月(36～84个月)。在随访时,通过X线片对患者的创伤性肱盂关节炎及肱骨头坏死情况进行评估;采用美国肩肘外科医师(American Shoulder and Elbow Surgeons,ASES)评分评估患者的临床效果。[结果]随访中发现,共有7例患者(26%)发生肱骨头坏死,肱骨头坏死出现的平均时间为内固定术后45个月(18～72个月)。所有10例NeerⅣ型患者中5例发生肱骨头坏死,发生率为50%;而12例NeerⅢ型患者中2例出现肱骨头坏死,发生率为17%;5例NeerⅡ型患者均未出现术后肱骨头坏死。所有27例患者中10例(37%)出现创伤性肱盂关节炎的影像学改变,NeerⅣ型患者的发生率为60%(6例);NeerⅢ型为33%(4例);5例NeerⅡ型患者均未发生创伤性肱盂关节炎。肱骨头坏死与无肱骨头坏死病例的平均ASES评分分别为(77.9±6.9)分和(83.6±7.1)分,未发生肱骨头坏死的病例其ASES评分较高,但差异无统计学意义(t=1.840,P=0.078)。创伤性肱盂关节炎与无创伤性关节炎病例的平均ASES评分分别为(79.6±7.2)分和(84.1±6.8)分,未发生创伤性肱盂关节炎患者的ASES评分较高,但差异无统计学意义(t=1.625,P=0.117)。[结论]肱骨近端骨折采用闭合复位经皮固定治疗后患者发生中期肱骨头坏死和创伤性关节炎的概率较高,但肱骨头坏死和创伤性关节炎的出现不会显著影响患者的临床评分结果。

[ Objective ] To determine the midterm results of case series of proximal humeral fractures treated with percuta- neous fixation. [ Method] Between 2005 and 2008, thirty -nine patients were treated with percutaneous reduction and fixation for proximal humeral fractures and were followed up. Twenty - seven of these patients were available for intermediate follow - up at a minimum of three years （mean,sixty months; range,36 to 84 months） after surgery; the follow - up examination included use of American Shoulder and Elbow Surgeons （ASES） score and radiographic analysis to identify osteonecrosis and posttrau- matic osteoarthritis on radiographs. [ Result] Osteonecrosis was detected in seven （26%） of the total group of twenty - seven patients at a mean of 45 months （range, 18 to 72 months） after the date of percntaneous fixation. Osteonecrosis was observed in five （50%） of the ten patients who had Neer IV type fractures,two （ 17% ） of the twelve patients who had Neer III type frac- tures, and none （0%） of the five patients who had Neer II type fractures. Posttraumatic osteoarthritis was present on radiographs in ten （37%） of the total group of twenty - seven patients. Posttraumatic osteoarthritis was observed in six （60%） of the ten patients who had Neer IV type fractures, four （33%） of the twelve patients who had Neer lII type fractures, and none （0%） of the five patients who had Neer II type fractures. The ASES scores for all patients with osteonecrosis （average ASES score,77.9 ±6.9） in the present study were lower as compared with the scores for patients without osteonecrosis （ average ASES score,83. 6 ± 7.1 ）, but this was not significant （t = 1. 840,P = 0.078 ）. The average ASES score for those patients without posttraumatic osteoarthritis was 84.1 ± 6.8 as compared with an average ASES score of 79.6 ± 7.2 for those with posttraumatic osteoarthritis, which was not significant （ t = 1. 625, P = 0.117 ）. [ Conclusion ] Intermediate follow - up of patients with percntaneously treated proximal humeral fractures demonstrates an increased prevalence of osteonecrosis and posttraumatic osteoarthritis over time. De- velopment of osteonecrosis and posttranmatic osteoarthritis did not have a universally negative impact on subjective outcomescores.