自体髂骨条植骨联合锁定钢板治疗Neer3/4型肱骨近端骨折的临床研究

A clinical study of autologous iliac crest graft combined with locking plate in the treatment of Neer 3/4 type proximal humeral fractures

目的探讨自体髂骨条植骨(AICG)联合肱骨近端锁定钢板(LPHP)治疗Neer3/4型肱骨近端骨折(PHF)的临床疗效。方法我院诊治的Neer3/4型PHF患者90例,其中44例行LPHP治疗(钢板组),46例行AICG联合LPHP治疗(联合组)。对比两组肩关节功能、活动度、疼痛评分、围术期指标和并发症情况。结果联合组手术时间和术中出血量高于钢板组,但骨痂出现时间、骨折愈合时间及住院时间均短于钢板组(P<0.05);术后2、3个月,联合组视觉模拟疼痛(VAS)评分低于钢板组(P<0.05);术后6个月、1年,联合组前屈上举、外展和内外旋度数高于钢板组(P<0.05);术后1年,联合组疼痛、日常活动、活动度和肌力分值高于钢板组(P<0.05);两组并发症比较差异无统计学意义(P>0.05)。结论AICG联合LPHP可缓解Neer3/4型PHF患者疼痛,促进肩关节恢复。

Objective To investigate the clinical effect of autologous iliac crest graft(AICG)combined with locking proximal humeral plate(LPHP)in the treatment of Neer 3/4 proximal humeral fractures(PHF).Methods This study involved 90 patients with Neer 3/4 PHF,including 44 patients treated with LPHP(plate group)and 46 patients treated with AICG combined with LPHP(combined group).Shoulder function,range of motion,pain score,perioperative indicators,and complications were compared between the two groups.Results The operative time and intraoperative blood loss of the combined group were longer or more than those of the plate group.The callus formation time,fracture healing time and length of hospital stay were shorter of the combined group than those of the plate group(P<0.05).The combined group had lower VAS score than the plate group after 2 and 3 months of operation(P<0.05).After 6 months and 1 year of operation,the ranges of forward flexion and upward lift,abduction,internal and external rotation in the combined group were greater than those in the plate group(P<0.05).After 1 year of operation,the scores for pain,activities of daily living,activity and muscle strength in the combined group were higher than those in the plate group(P<0.05).There was no statistically significant difference in complications between the two groups(P>0.05).Conclusion AICG combined with LPHP can relieve the pain and promote the shoulder recovery in patients with Neer 3/4 PHF.