背景老年肱骨近端骨折是一种常见的脆性骨折,重建内侧柱稳定性是治疗的关键,但重建方式存在差异。目的比较新型解剖髓内支撑系统与钢板结合髂骨髓内支撑治疗老年肱骨近端骨折的疗效差异。方法回顾性分析解放军总医院骨科医学部2018年9月...背景老年肱骨近端骨折是一种常见的脆性骨折,重建内侧柱稳定性是治疗的关键,但重建方式存在差异。目的比较新型解剖髓内支撑系统与钢板结合髂骨髓内支撑治疗老年肱骨近端骨折的疗效差异。方法回顾性分析解放军总医院骨科医学部2018年9月-2021年6月收治的肱骨近端骨折老年患者。根据治疗方式分为新型解剖髓内支撑系统组和钢板结合自体髂骨移植组。比较两组手术时间、术中出血量、切口长度、复位质量、疼痛视觉模拟评分(visual analog scale,VAS)以及末次随访时的肩关节功能Constant-Murley评分、生活能力DASH(disability of the arm,shoulder,and hand)评分、并发症等方面的差异。结果共纳入47例老年肱骨近端Neer分型骨折患者,男12例,女35例;三部分骨折25例,四部分骨折22例。新型解剖髓内支撑系统组22例,钢板结合自体髂骨移植组25例,两组一般资料差异无统计学意义(P均>0.05)。平均随访时间为18.4个月,所有患者均获得骨性愈合,观察组的切口长度、术中出血量、手术时间均短于/少于对照组[(6.43±0.78)cm vs(10.74±0.81)cm,(192.27±55.02)mL vs(250±57.8)mL,(101.27±13.8)min vs(116.72±11.24)min],差异有统计学意义(P均<0.05)。术后3个月与术后第1天相比,观察组颈干角变化值小于对照组[(0.71±0.63)°vs(3.2±1.14)°,P<0.05]。两组在末次随访时VAS疼痛评分、Constant-Murley评分、DASH评分均无统计学差异(P>0.05)。结论与自体髂骨联合钢板组相比,新型解剖髓内支撑系统组具有创伤小、维持复位能力强等优点。展开更多
Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with...Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.展开更多
文摘背景老年肱骨近端骨折是一种常见的脆性骨折,重建内侧柱稳定性是治疗的关键,但重建方式存在差异。目的比较新型解剖髓内支撑系统与钢板结合髂骨髓内支撑治疗老年肱骨近端骨折的疗效差异。方法回顾性分析解放军总医院骨科医学部2018年9月-2021年6月收治的肱骨近端骨折老年患者。根据治疗方式分为新型解剖髓内支撑系统组和钢板结合自体髂骨移植组。比较两组手术时间、术中出血量、切口长度、复位质量、疼痛视觉模拟评分(visual analog scale,VAS)以及末次随访时的肩关节功能Constant-Murley评分、生活能力DASH(disability of the arm,shoulder,and hand)评分、并发症等方面的差异。结果共纳入47例老年肱骨近端Neer分型骨折患者,男12例,女35例;三部分骨折25例,四部分骨折22例。新型解剖髓内支撑系统组22例,钢板结合自体髂骨移植组25例,两组一般资料差异无统计学意义(P均>0.05)。平均随访时间为18.4个月,所有患者均获得骨性愈合,观察组的切口长度、术中出血量、手术时间均短于/少于对照组[(6.43±0.78)cm vs(10.74±0.81)cm,(192.27±55.02)mL vs(250±57.8)mL,(101.27±13.8)min vs(116.72±11.24)min],差异有统计学意义(P均<0.05)。术后3个月与术后第1天相比,观察组颈干角变化值小于对照组[(0.71±0.63)°vs(3.2±1.14)°,P<0.05]。两组在末次随访时VAS疼痛评分、Constant-Murley评分、DASH评分均无统计学差异(P>0.05)。结论与自体髂骨联合钢板组相比,新型解剖髓内支撑系统组具有创伤小、维持复位能力强等优点。
文摘Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.
