同种异体腓骨移植预防老年粉碎性肱骨近端骨折术后内翻及塌陷的效果

Effect of fibular allograft transplantation on prevention of inversion and sag after comminuted proximal humerus fracture operation in the elderly

目的研究同种异体腓骨移植联合锁定钢板在预防老年粉碎性肱骨近端骨折术后肱骨头内翻及塌陷的效果。方法整理2015年1月—2018年12月北京积水潭医院创伤骨科收治的72例老年粉碎性肱骨近端骨折患者的临床资料。依据手术方式将其分为两组,其中采用单纯锁定钢板治疗的为钢板组(41例),采用同种异体腓骨移植联合锁定钢板治疗的为移植组(31例)。比较两组手术时间、术中出血量。比较两组随访时间、末次随访视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)肩关节功能评分、Constant肩关节评分。比较两组术后和末次随访的颈干角、肱骨头高度变化。结果两组手术时间、术中出血量、随访时间、末次随访VAS比较,差异无统计学意义(P>0.05)。移植组末次随访UCLA肩关节功能评分、Constant肩关节评分均高于钢板组,差异均有统计学意义(均P<0.05)。两组末次随访的颈干角、肱骨头高度均低于术后,且移植组高于钢板组,差异均有统计学意义(均P<0.05)。结论同种异体腓骨移植联合锁定钢板治疗老年粉碎性肱骨近端骨折具有良好的抗肱骨头内翻与塌陷的效果,可以提升患者预后。

Objective To study the effect of fibular allograft transplantation combined with locking plate on prevention of inversion and sag after comminuted proximal humerus fracture operation in the elderly.Methods Clinical data of 72 elderly patients with comminuted proximal humerus fractures admitted to Beijing Jishuitan Hospital from January 2015 to December 2018 were summarized.The patients were divided into two groups according to the operative methods:the plate group(41 cases)treated with locking plate alone,and the graft group(31 cases)treated with fibular allograft transplantation combined with locking plate.The operative time and intraoperative blood loss were compared between the two groups.The follow-up time,visual analogue scale(VAS)at last follow-up,University of California,Los Angeles(UCLA)shoulder function score and Constant shoulder score were compared between the two groups.The changes of neck-shaft angle and humeral head height were compared between the two groups after operation and the last follow-up.Results There were no significant differences in operative time,intraoperative blood loss,follow-up time and VAS at the last follow-up between the two groups(P>0.05).UCLA shoulder function score and Constant shoulder score in the graft group were higher than those in the plate group at the last follow-up,with statistical significance(all P<0.05).The neck-shaft angle and humeral head height in the last follow-up in both groups were lower than those after operation,and those in the graft group were higher than those in the plate group,with statistical significance(all P<0.05).Conclusion Fibular allograft transplantation combined with locking plate in the treatment of comminuted proximal humerus fractures in elderly has a good effect of inversion and sag of the humerus head,and can improve the prognosis of patients.