双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折

Double plate technique and tendon fixation of long head of biceps brachii in treating Neer 3 to 4 partial fractures of proximal humerus

目的:探讨采用双钢板技术同时进行肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折的临床疗效。方法:2018年5月至2020年12月采用双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折患者38例,其中男23例,女15例;年龄41~89(67.00±9.76)岁;Neer 3部分骨折23例,Neer 4部分骨折15例;伤后至手术时间5~12(8.00±2.86)d。术后第3天采用单维度疼痛数字评分法(numeric rating scale,NRS)评估疼痛程度;比较术后2 d及1年时肱骨头高度、肱骨颈干角变化情况;术后1年采用Neer评分评定术后肩关节恢复情况。结果:38例患者均获得随访,时间12~19(14.00±1.59)个月。术后3 d时NRS评分(1.95±0.73)分。骨折愈合时间2.2~3.2(2.60±0.27)个月。术后2 d与1年时肱骨头高度、肱骨颈干角比较,差异无统计学意义(P>0.05)。4例Neer 4部分骨折出现肱骨大结节吸收、肱骨头出现部分囊性变,但肩关节活动功能良好。术后1年Neer评分(89.50±5.19)分,其中优20例,良16例,中2例。结论:采用双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折,治疗效果良好,术后疼痛较轻,手术无须特殊器械。

Objective:To explore clinical effect of double plate technique in treating Neer 3 to 4 partial fractures of proximal humerus.Methods:From May 2018 to December 2020,38 patients with proximal humeral classified to Neer 3 to 4 partial fractures were treated with double plate technique and long head tendon fixation of biceps brachii,including 23 males and 15 females,aged from 41 to 89 years old with an average of(67.00±9.76)years old;23 patients classified to Neer 3 fracture,15 classified to Neer 4 fracture;the time from injury to operation ranged from 5 to 12 days with an average of(8.00±2.86)days.Degree of pain was evaluated by numerical rating scale(NRS)on the third day after operation;change of height of humeral head and angle of humeral neck stem were measured and compared between 2 days and 1 year after operation.Neer score was used to evaluate recovery of shoulder joint after operation at 1 year after operation.Results:All 38 patients were followed up for 12 to 19 months with an average of(14.00±1.59)months.NRS score at 3 days after operation was(1.95±0.73)points.Fracture healing time ranged from 2.2 to 3.2 months with an average of(2.60±0.27)months.There were no significant difference in the height of humeral head and angle of humeral neck trunk between two days and 1 year after operation(P>0.05).Four Neer 4 fracture patients occurred absorption of greater tubercle of humerus and partial cystic change of humeral head,but the activity function of shoulder joint was good.Postoperative Neer score at 1 year was 89.50±5.19,and 20 patients got excellent results,16 good,and 2 moderate.Conclusion:Double plate technique and long head tendon fixation of biceps brachii were used to treat Neer 3 to 4 fractures of proximal humerus has good clinical effect,and postoperative pain was mild,without special instruments.