有限切开复位髓内钉治疗高龄Neer二部分及三部分肱骨近端骨折

Limited open reduction and intramedullary nail for the treatment of Neer II and III type proximal humeral fractures in elderly patients

目的探讨有限切开复位髓内钉治疗高龄Neer二部分及三部分肱骨近端骨折的临床疗效。方法自2012年1月~2016年6月,31例高龄肱骨近端骨折患者采用有限切开复位髓内钉治疗,年龄75~90岁,平均81岁,按Neer分型,二部分骨折21例,三部分骨折10例,手术方法均采用肩峰前外侧切口,长度约6 cm左右,有限切开复位后行锁定型髓内短钉固定,手术时间平均70分钟,术中出血80 m L^100 m L,术后指导患者功能锻炼。结果本组31例手术患者均获得6~12个月的随访,平均8个月,随访内容包括骨折愈合及关节功能恢复情况。所有患者均获骨性愈合,愈合时间为6~10周,平均8周,未发生切口感染,神经血管损伤及内固定松动。并发症:肩峰撞击综合征3例(2例螺钉尾端位置偏高,1例大结节术后再移位),按照Neer肩关节功能评分标准,本组病例,优8例,良18例,可4例,差1例,全组优良率83%。结论有限切开复位髓内钉治疗Neer二部分及三部分肱骨近端骨折高龄患者,具有手术创伤小、内固定可靠及手术时间短等优势,疗效满意。

Objective To evaluate the outcome of the intramedullary nail in the treatment of Neer Ⅱ and Ⅲ type proximal humeral fractures. Methods A total of 31 elderly patients with proximal humeral fractures classified as Neer Ⅱ or Ⅲ type underwent internal fixation operation using a intramedullary nail from Jan 2012 to Jun 2016. The patients aged 75 to 90, and the mean age was 81 years old. The patients were classified as Neer Ⅱ included 21 cases and in type included 10 cases. The treatment was consisted of open reduction, internal fixation with an intramedullary nail through an about 6 cm length proximal anterior lateral incision. Functional exercise guidance were provided post operation. Results All 31 patients were follow-up after operation. Following up included fracture healing and joint function recovery. The mean operation time was 70 minutes. The mean bleeding during operation was about 80 mL. The mean follow-up period was 8 （range, 6 -12） months. All fractures achieved union after a mean of 8 （range, 6 - 1 0 ） weeks. The final Neer shoulder fimction scores was excellent in 8 patients, good in 18,moderate in 4, and poor in 1. The total excellent and good rate of patients was 83%. Three case occurred postoperative aiguillette collision. There was no superficial infection, the nerve and vascular injury and loosening or breakage of internal fixation complications. Conclusion The intramedullary nail can reduce the operative time and the risk of the anesthesia. This fixation devices promotes the surgical effects with the advantages of minimal injury and strong internal fixation.