自体髂骨块植骨结合Calcar螺钉重建内侧柱治疗复杂肱骨近端骨折

Medial column reconstruction with autogenous iliac bone graft and Calcar screw for treatment of complex proximal humeral fractures

目的探讨自体髂骨块移植结合Calcar螺钉重建内侧柱治疗肱骨近端骨折的临床疗效。方法回顾性分析我院自2016年1月至2018年12月收治的36例单侧复杂肱骨近端骨折患者,采用自体髂骨块移植结合Calcar螺钉治疗。随访时间12~24个月,平均17.04个月。记录术后3、6、12个月随访时Neer肩关节功能评分(Neer评分)和肩关节功能评分(Constant评分);采用视觉模拟评分(visual analogue scale,VAS)评估患者术后疼痛程度。分析患者骨折愈合时间、并发症发生情况及肩关节活动范围。结果36例患者均达到解剖复位,骨折平均愈合时间为3.71个月,没有患者出现肱骨头缺血性坏死及内翻塌陷。术后12个月随访时,患者Neer评分(84.64±3.40)分;Constant评分(74.26±4.70)分;VAS(1.24±0.72)分。患肩关节活动度:屈(132.58±8.01)°、伸(43.75±3.41)°、内旋(58.25±4.89)°、体侧外旋(58.89±4.83)°、外展(136.46±11.04)°。结论对于内侧粉碎性复杂肱骨近端骨折,自体髂骨块植骨结合Calcar螺钉能够重建可靠的内侧支撑,降低内翻塌陷及肱骨头缺血性坏死等并发症的风险,术后功能恢复满意。

Background In recent years,the incidence of proximal humeral fractures has been increasing year by year,reaching 4%to 5%of systemic fractures.With the progress of the aging population,the incidence of significantly displaced proximal humeral fractures has increased by 50%.Early open reduction and internal fixation(ORIF)has become a consensus in treating complex proximal humeral fractures.However,in the complex Neer part-3 or 4 proximal humerus fractures,the destroyed medial humeral support structure will significantly negatively impact postoperative functional recovery.The current research believes that providing reliable medial support while reducing the fracture is significant for decreasing postoperative complications and achieving good functional recovery.However,there are different opinions on the selection of support methods.Objective To explore the clinical effect of medial column reconstruction with autogenous iliac bone graft and Calcar screw in the treatment of proximal humeral fractures.Methods From January 2016 to December 2018,36 patients with unilateral complex proximal humeral fractures were treated in our hospital with autogenous iliac bone graft combined with Calcar screw.The follow-up period ranged from 12 to 24 months,with an average of 17.04 months.Neer shoulder function score and Constant-Murley score were recorded at 3rd,6th,and 12th months after the operation,and the degree of postoperative pain was evaluated with visual analogue scale(VAS).The time of fracture healing,complications,and the range of motions of the shoulder joint were analyzed.Results All 36 patients achieved anatomical reduction,and the average healing time of the fractures was 3.71 months.No avascular necrosis(AVN)of the humeral head or varus collapse occurred.In the 12-month follow-up,the Neer function score,Constant-Murley score,and VAS score were(84.64±3.40),(74.26±4.70),and(1.24±0.72),respectively.The range of motions of the affected shoulder joint were(132.58±8.01)°of flexion,(43.75±3.41)°of extension,(58.25±4.89)°of internal rotation,(58.89±4.8)°of external rotation,and(136.46±11.04)°of abduction.Conclusion For complex proximal humeral fractures with medial comminution,autogenous iliac bone graft combined with Calcar screw can provide reliable medial support,reduce the risk of varus collapse,AVN,and other complications,and the postoperative functional recovery is satisfactory.