异体腓骨辅助解剖复位对肱骨近端骨折预后的影响

Effect of fibular strut allograft-assisted anatomical reduction on prognosis of proximal humeral fractures

目的探讨使用异体腓骨辅助治疗肱骨近端骨折解剖复位对患者预后的影响。方法回顾性分析2015年11月—2016年3月上海交通大学附属第六人民医院使用异体腓骨辅助治疗NeerⅢ型、NeerⅣ型肱骨近端骨折获得解剖复位的患者共23例,最终14例患者获得满意随访(解剖复位组)。随机挑选同期诊治的未接受异体腓骨辅助复位而仅达到功能复位的NeerⅢ型、NeerⅣ型肱骨近端骨折患者14例作为对照组。两组均于术后3、6、12个月记录Constant Murley肩关节功能评分和Quick DASH满意度自查评分。结果解剖复位组术后3、6、12个月的Constant Murley肩关节功能评分分别为(67.7±8.4)、(72.4±16.6)、(76.8±14.8)分,Quick DASH满意度自查评分分别为(7.7±4.6)、(6.7±3.7)、(5.1±3.6)分;对照组术后3、6、12个月的Constant Murley肩关节功能评分分别为(59.6±7.1)、(69.9±13.5)、(75.1±10.3)分,Quick DASH满意度自查评分分别为(7.9±3.5)、(7.3±2.6)、(5.5±2.9)分。解剖复位组术后3个月的Constant Murley肩关节功能评分和术后3、6、12个月的Quick DASH满意度自查评分均显著优于对照组(P值均<0.05),两组间术后6、12个月的Constant Murley肩关节功能评分的差异无统计学意义(P值均>0.05)。解剖复位组患者术后3个月时肩关节活动状态满意。结论异体腓骨辅助治疗肱骨近端骨折解剖复位对于促进患者早期康复、减轻肩关节疼痛和改善僵硬症状有着积极的作用。

Objective To explore the effect of fibular strut allograft-assisted anatomical reduction on the prognosis of proximal humeral fractures. Methods In this retrospective study, 23 patients with Neer Ⅲ or proximal humeral fractures treated with fibular strut allograft-assisted anatomical reduction in Shanghai Sixth People＇s Hospital between November 2015 and March 2016 were enrolled, and eventually 14 patients received satisfying follow-up. Meanwhile, 14 patients with Neer Ⅲ or Ⅳ proximal humerus fractures, who were treated in the hospital in the same period but received no anatomical reduction, were randomly chosen as control group. The patients were assessed by Constant Murley Score and Quick DASH questionnaire. Results The Constant Murley Score at 3, 6 and 12 months postoperatively in anatomical reduction group were 67.7 ＋ 8.4, 72.4 ＋ 16.6 and 76.8-＋ 14,8, respectively; and were 59.6 ± 7. 1, 69.9 ± 13.5 and 75. 1 ± 10.3 in control group. There was significant difference in the Constant Murley Score 3 months postoperatively between two groups （P〈0.05）. The Quick DASH questionnaire score 3, 6 and 12 months postoperatively in anatomical reduction group were significantly lower than those in control group （7.7 ± 4.6 vs. 7.9 ± 3.5, 6.7 ± 3.7 vs. 7.3 ± 2.6, 5.1± 3.6 vs. 5.5±2.9, all P〈0. 05）. Conclusion The fibular strut allograft-assisted anatomical reduction can promote early rehabilitation, reduce the pain and the rigidity of shoulder joint in the treatment of proximal humeral fractures.