内侧支撑重建增强固定技术在肱骨近端骨折治疗中的研究进展

Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures

目的对内侧支撑重建增强固定技术在肱骨近端骨折治疗中的临床应用和生物力学研究进展进行综述,为肱骨近端骨折的临床治疗提供参考。方法查阅近年国内外有关肱骨近端骨折内侧支撑重建增强固定技术的文献,并进行总结分析。结果对于肱骨近端骨折,尤其是合并严重骨质疏松和/或粉碎性骨折,在现有锁定钢板基础上进行内侧支撑增强固定十分必要。内侧支撑重建增强固定技术主要分为髓外支撑和髓内支撑,进一步可根据支撑物材料和来源分为自体骨和同种异体骨支撑,根据支撑位点分为内侧柱支撑、Calcar区支撑和肱骨头支撑,根据增强固定物形态可分为腓骨干、股骨头、解剖型腓骨等支撑。临床研究和生物力学试验结果表明内侧支撑重建增强固定技术是肱骨近端骨折重要的增强固定方式。结论内侧支撑重建增强固定技术作为肱骨近端骨折最为重要的治疗策略,是当前临床治疗和研究的热点,但对于支撑方式、支撑位点、支撑物形态和种类等问题尚存在广泛争议,仍需要更多高质量临床研究和生物力学试验提供循证医学证据以及进行多学科有机融合探究,以期为肱骨近端骨折的治疗提供更优选择。

Objective To review the literature about the clinical application and research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures,and to provide reference for clinical treatment.Methods The literature concerning medial support augmentation of plate osteosynthesis for proximal humeral fractures in recent years was extensively reviewed,as well as the biomechanical benefit and clinical advantage were analyzed thoroughly.Results Medial support augmentation of plate osteosynthesis for proximal humeral fractures is very important,especially in osteoporotic and/or comminuted fractures.Many medial support augmentation methods have been proposed which can be divided into extramedullary support and intramedullary support.It can also be divided into autogenous bone support and allogenic bone support according to the material and source,divided into medial column support,calcar support,and humeral head support according to the support site,and divided into fibular shaft support,femoral head support,anatomic fibula support according to the shape of the augmented fixation.At present,clinical and biomechanical researches show that medial support augmentation is an effective treatment for proximal humeral fractures.Conclusion As an important treatment strategy for the treatment of proximal humeral fractures,the medial support augmentation of plate osteosynthesis gets the focus from the biomechanical studies and clinical treatment.However,there are still widespread controversies among orthopedic surgeons regarding the support mode,site,implant shape,and material of medial column support for augmentation of proximal humeral fractures.More high-quality clinical trials and biomechanical researches as well as multi-disciplinary integration,are needed to provide better strategy treatment for the treatment of proximal humeral fractures.