肱骨近端骨折“时间-角度测量”复位评估技术及临床疗效评估

“Time-angle measurement” reduction evaluation technique and clinical evaluation of proximal humerus fracture

目的:探讨肱骨近端骨折行切开复位内固定治疗时,结合"时间-角度测量"复位评估技术指导肱骨头骨折块复位和固定治疗的临床效果及并发症发生情况。方法:回顾性分析2012年1月至2013年12月间收治的46例肱骨近端骨折患者[平均年龄(66.2±14.9)岁]的临床资料,根据Neer分型,两部分骨折患者有6例,三部分骨折患者25例,四部分骨折患者15例,均接受切开复位钢板内固定结合"时间-角度测量"复位评估技术的手术治疗,通过Constant评分系统评价患者术后肩关节功能恢复情况,同时随访患者影像学检查结果并记录并发症的发生情况,评价此复位评估技术对于该类骨折临床治疗的指导意义。结果:46例患者均获得13~36个月的随访,平均随访时间(23.5±7.3)个月,所有患者在术后3个月时行X线检查均达到骨折愈合,平均的头干角为124°±3.5°。患者术后Constant评分显示:优29例(63%),良14例(30%),差3例(7%)。术后合并肩关节疼痛者7例,合并肩关节活动受限5例。术后随访未发现螺钉穿出、肱骨头坏死、深部组织感染、骨折不愈合及腋神经损伤的病例。结论:对于肱骨近端两部分、三部分甚至四部分骨折,采用切开复位内固定治疗时结合"时间-角度测量"复位评估技术能够有效地指导肱骨近端骨折后肱骨头的复位和固定,从而达到良好的临床治疗效果。

Objective： To evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with a ＂time-angle measurement＂reduction evaluation technique,to assess the acceptance of the fracture reduction and to estimate the result of the surgery. Methods： Forty-six patients [mean age：（ 66. 2 ± 14. 9） years] with an acute proximal humeral fracture were managed with open reduction and internal fixation with this reduction evaluation technique from January 2012 to December 2013. According to the Neer classification,there were 6 two-part fractures,25 three-part fractures and 15 four-part fractures. The functional outcome was evaluated for each patient using the Constant-Murley score; radiographic evaluation was also conducted and complications were recorded. The postoperative shoulder function recovery and imaging findings were followed up to evaluate the guiding significance of this reduction evaluation technique in the clinical treatment of this kind of fracture. Results： In the study,46 patients had been followed up for 13-36 months,and the average follow-up time was（ 23. 5 ± 7. 3） months. All the patients achieved fracture healing 3 months after operation. The average head-shaft angle was（ 124 ± 3. 5） degrees. According to the Constant scoring system,29 patients（ 63%） had excellent,14 patients（ 30%） had good,and 3 patients（ 7%） had poor results. The most common complications were pain（ 7/65） and restricted movement of the shoulder（ 5/46）. There were no cases of screw penetration,necrosis of humeral head,deep tissue infection,nonunion of fracture and axillary nerve injury after operation. Conclusion： For appropriate cases of displaced proximal humeral fractures,surgical treatment with application of ＂time-angle measurement＂reduction evaluation technique that was introduced in the present study can lead to a good functional outcome,and the technique of reduction assessment should be regarded as a reasonable reference standard in the treatment of displaced proximal humerus fracture.