自体髂骨移植结合锁定钢板内固定治疗肱骨近端粉碎性骨折的前瞻性研究

Clinical effects of autogeneic iliac bone grafting combined with locking plate in the treatment of proximal humerus comminuted fracture

目的探讨自体髂骨移植结合锁定钢板内固定治疗肱骨近端粉碎性骨折的临床疗效。方法选择2013年9月至2015年11月,我院收治的62例肱骨近端粉碎性骨折患者作为研究对象,采用随机数字表法将患者分为观察组(n=30)和对照组(n=32),对照组予以锁定钢板内固定治疗,观察组予以自体髂骨移植结合锁定钢板内固定治疗。两组均随访12~24个月,平均12.47个月。比较两组术后3、6、12个月Neer肩关节功能评分和Constant-Murky肩关节功能评分;采用视觉模拟评分(visual analogue scale,VAS)对疼痛进行评分,采用简明健康状况调查表(SF-36)对患者的健康状况进行调查。比较两组骨折愈合时间、肩关节活动范围、VAS评分、SF-36得分及并发症发生率。结果观察组骨折愈合时间早于对照组,两组相比差异有统计学意义(P=0.010);术后观察组屈、伸、内旋、外旋及外展的度数均大于对照组,两组相比差异有统计学意义(P=0.029);术后3、6、12个月观察组Neer肩关节功能评分、Constant-Murky肩关节功能评分和SF-36评分均高于对照组,两组相比差异有统计学意义(P=0.010);术后观察组VAS评分及并发症发生率均低于对照组,两组相比差异有统计学意义(P=0.008)。结论自体髂骨移植结合锁定钢板内固定治疗肱骨近端粉碎性骨折,可促进骨折快速愈合,肩关节功能恢复,降低并发症发生率,改善患者生活质量,值得临床推广。

Objective To explore the clinical effects of autogeneic iliac bone grafting combined with locking plate in the treatment of proximal humerus comminuted fracture. Methods From September 2013 to November 2015, 62 patients were selected. All patients were divided into the observation group（ n = 30） and the control group（ n = 32） by digital random table method. The control group was treated with locking plate fixation, while the observation group was treated with locking plate combined with autogeneic iliac bone grafting. All patients were followed up for 12-24 months（ mean： 12.47 months）. The Neer shoulder function score and Constant-Murky shoulder function score were compared between the 2 groups at 3, 6 and 12 months after operation. The visual analogue scale（ VAS） was used to evaluate the pain. SF-36 was used to investigate the health status. The time of fracture healing, the range of shoulder joint activity, VAS score, SF-36 score and the incidence of complications were compared between the 2 groups. Results The fracture healing time of the observation group was shorter than that of the control group（ P = 0.010）. The degree of flexion, extension, internal rotation, external rotation and abduction in the observation group after operation was better than that of the control group（ P = 0.029）. At 3, 6 and 12 months after operation, Neer shoulder function score and Constant-Murky shoulder function score of the observation group were higher than those of the control group（ P = 0.010）. After the operation, the VAS score of the observation group was lower than that of the control group（ P = 0.008）. After the operation, the SF-36 score of the observation group was higher than that of the control group（ P = 0.010）. The incidence of complications in the observation group was lower than that of the control group（ P = 0.008）. Conclusions Autologous iliac bone graft combined with locking plate fixation in the treatment of proximal humeral comminuted fractures can promote quicker fracture healing and shoulder joint function recovery, meanwhile reduce complications and improve quality of life. It is worthy of clinical promotion.