闭合复位经皮螺纹克氏针内固定治疗肱骨外科颈骨折

Treatment of humeral surgical neck fractures with closed reduction and percutaneous threaded pin fixation

目的 探讨俯卧位下闭合复位经皮螺纹克氏针内固定治疗二部分肱骨外科颈骨折的方法及结果。方法 回顾性分析自2002-06—2014-04采用俯卧位下闭合复位经皮螺纹克氏针内固定治疗Neer二部分肱骨外科颈骨折56例。闭合复位满意后,于三角肌止点处与肱骨干轴线成角20°~30°逆行置入3枚直径2.5 mm末端带有螺纹的克氏针至肱骨头中心再到达软骨下骨。结果 本组解剖复位50例,近似解剖复位6例。56均获得随访6~25个月,平均13个月。骨折愈合时间1.5~2.5个月,平均2.1个月。末次随访时肩关节功能：前屈上举130°~170°,平均160°;内旋35°~70°,平均50°;外旋40°~55°,平均50°;后伸20°~40°,平均35°。JOA评分78~100分,平均94分;优38例,良16例,可2例,优良率96.4%。结论俯卧位下闭合复位经皮螺纹克氏针内固定治疗Neer二部分肱骨外科颈骨折操作简单,符合生物接骨理念,术后可早期功能锻练,减少并发症,是一种有效的临床治疗方法。

Objective To summarize the method and results of treatment of 2-part fractures of humeral surgical neck with closed reduction and percutaneous threaded pin fixation under the prone position. Methods The results of 56 patients with 2-part fractures of the humeral surgical neck treated with closed reduction and percutaneous threaded pins fixation under the prone position were retrospectively reviewed. After stable fixation was evident, size 2.5 partially threaded K-wires were selected for fixation. Kept at 20° to 30°angles with the humeral shaft, the pins were inserted directly beneath the insertion of the deltoid into the humerus towards the humeral head. Three pins were inserted in each case, reaching the subchondral hone of the humeral head. Results Fifty-six cases were followed for a mean of 13 months （6 to 25 months）, 50 had anatomical reduction and 6 had nearly anatomical reduction. All of the fractures united in 1.5 to 2.5 months （average, 2.1 months）. All of the cases achieved better outcome of shoulder joint functions at the last follow-up. The average forward flexion and elevation was 160°（range, 130°-170°）, the average intemal rotation was 50°（range, 35°-70°）, the average external rotation was 45°（range, 40°-55°） and the average rear protraction was 35°（range, 20°-40°）. The mean JOA score was 94（range, 78-100） out of 100. Thirty eight cases showed excellent results, 16 good, 2 fair. The good and excellent rate was 96.4%. Conclusion Treatment of 2-part fractures of humeral surgical neck with closed reduction and pereutaneous threaded pin fixation under the prone position can be operated simply, lessen soft tissue lesion and provide reliable fixation, and allow early functional exercise after operation and decrease complications. It is a kind of effective clinical treatment.