肱骨近端锁定钢板结合同种异体骨移植增强固定治疗肱骨近端骨质疏松骨折

Proximal humerus locking plate combined with allogeneic bone graft in the treatment of proximal humerus osteoporotic fractures

背景:老年肱骨近端骨质疏松骨折发病率逐年增加,由于骨质疏松导致抗力性明显降低,使骨折修复产生困难。目的:肱骨近端锁定钢板结合同种异体骨移植为一种有效的增强固定方法,分析两种方法结合对肱骨近端骨质疏松骨折的修复效果。方法:纳入河北北方学院附属第二医院2013年12月至2018年11月收治的肱骨近端骨质疏松骨折老年患者50例,按照不同的手术方法分为A组(n=30)和B组(n=20),A组使用肱骨近端锁定钢板辅以同种异体骨移植加强固定治疗,B组单独使用肱骨近端锁定钢板治疗。比较两组术后颈干角的变化、肱骨头高度丢失、骨折愈合时间以及手术前、后肩关节功能,记录并发症发生情况。结果与结论:①相对于B组,A组术后肱骨颈干角与正常较为接近(t=5.226,P<0.001),肱骨头高度丢失显著减少(t=2.609,P=0.012),肱骨近端骨折的愈合时间显著缩短(t=2.036,P=0.047);②术后3个月两组患者疼痛、功能、运动限制及解剖复位评分相对于术前均显著提高(t=4.731,6.707,4.370,6.196,P<0.01),并且A组显著优于B组;A组优良率为90%(27/30),显著高于B组的60%(12/20)(χ^(2)=6.294,P=0.012);③术后随访3个月,A组中未出现因为同种异体骨移植发生感染的病例,2例患者出现一过性发热,2例肩关节僵硬,并发症发生率为7%;B组中出现1例内固定失败,1例螺钉穿出,1例钢板断裂,3例肩关节僵硬,并发症发生率为30%;A组并发症发生率显著低于B组(χ^(2)=4.861,P=0.027);④提示同种异体骨移植结合肱骨近端锁定钢板的加强固定方法可明显促进肱骨近端骨质疏松骨折的愈合,改善肩关节的运动功能,并发症少,临床效果明显优于单独使用肱骨近端锁定钢板治疗。

BACKGROUND:The incidence of proximal humerus osteoporotic fractures increases year by year.Fracture repair is difficult because of the greatly reduced resistance caused by osteoporosis.OBJECTIVE:To investigate the clinical effect of proximal humerus locking plate combined with allogeneic bone transplantation(an effective method of augmentation fixation)in the treatment of proximal humerus osteoporotic fracture.METHODS:A total of 50 elderly patients with proximal humerus osteoporotic fracture from December 2013 to November 2018 in the Second Affiliated Hospital of Hebei North University were divided into group A(n=30)and group B(n=20)according to different surgical methods.In group A,proximal humerus locking plate supplemented by allogeneic bone transplantation was used for strengthening fixation,while in group B,proximal humerus locking plate was used alone.The changes of post-operative neck shaft angle,the loss of humeral head height,the time of fracture healing,and the shoulder joint function before and after operation were compared between the two groups,and the complications between the two groups were recorded.RESULTS AND CONCLUSION:(1)Compared with group B,group A had no significant reduction in postoperative humeral neck shaft angle compared with normal group(t=5.226,P<0.001),the loss of humeral head height was significantly reduced(t=2.609,P=0.012),and the healing time of proximal humerus fracture was significantly shortened(t=2.036,P=0.047).(2)Three months after surgery,the scores of pain,function,movement limitation and anatomic reduction in the two groups were all significantly increased compared with those before surgery(t=4.731,6.707,4.370,6.196,P<0.01),and the scores in the group A were significantly better than those in the group B.The excellent and good rate was 90%(27/30)in group A,significantly higher than 60%(12/20)in group B(χ^(2)=6.294,P=0.012).(3)After a follow-up of three months after surgery,there were no cases of infection due to allogeneic bone transplantation in group A,and two patients experienced transient fever.There were two cases of shoulder joint stiffness,and the complication rate of surgery was 7%.In group B,internal fixation failure occurred in one case,screw penetration occurred in one case,steel plate fracture occurred in one case,and shoulder joint stiffness occurred in three cases.The complication rate was 30%.The incidence of complications in group A was significantly lower than that in group B(χ^(2)=4.861,P=0.027).(4)It is indicated that the method of allogeneic bone transplantation combined with proximal humerus locking plate strengthening fixation can significantly promote the healing of proximal humerus osteoporotic fractures and improve the motor function of shoulder joint,with less complications.The clinical effect is obviously superior to that of using proximal humerus locking plate alone.