增强固定技术用于冰雪运动所致肱骨近端骨质疏松骨折治疗的研究
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摘要
目的探讨增强固定技术在冰雪运动所致肱骨近端骨质疏松骨折中的应用效果。方法搜集因冰雪运动或冬季地面结冰滑倒导致肱骨近端骨质疏松骨折的老年患者65例,依据固定方式不同分为A(n=26)、B(n=21)、C(n=18)3组,3组均采用肱骨近端锁定内固定进行治疗,A组采用磷酸钙骨水泥增强固定,B组采用同种异体骨条增强固定,C组单纯实施锁定钢板螺钉固定。比较3组骨折愈合时间、术后颈干角、肱骨头高度丢失及手术前后肩关节功能和肩关节各方向活动度,记录3组并发症发生情况。结果与C组比较,A、B 2组骨折愈合时间更短(P均<0.05),术后颈干角更大(P均<0.05),肱骨头高度丢失更小(P均<0.05);但A、B 2组间比较无明显差异(P均>0.05)。与术前比较,术后2个月3组患者疼痛、功能、运动限制及解剖复位评分均明显升高(P均<0.05),且A、B 2组均明显高于C组(P均<0.05);但A、B 2组间比较无明显差异(P均>0.05)。与术前比较,术后1周3组患者肩关节前屈、后伸、内收、外展时活动度均明显增加(P均<0.05),且A、B 2组均明显大于C组(P均<0.05)。A、B 2组并发症发生率均明显低于C组(P<0.05),A、B 2组间比较无明显差异(P>0.05)。结论增强固定技术治疗冰雪运动所致肱骨近端骨质疏松骨折,可明显促进骨折愈合,改善肩关节功能及活动度,并发症少,有利于术后患者康复。
Objective It is to investigate the applicating effect of enhanced fixation technique on the proximal humeral osteoporotic fracture caused by ice and snow exercise. Methods A total of 65 elderly patients with osteoporosis fractures of the proximal tibia caused by snow and ice or winter ground icing slips were collected and divided into group A(n=26), group B(n=21) and group C(n=18) according to their fixation methods. All the three groups were treated with proximal humeral locking and internal fixation, group A was fixed with calcium phosphate cement, and group B was fixed with allogeneic bone strip, Group C was simply fixed with a locking plate screw. The fracture healing time, postoperative neck shaft angle, humeral head height loss and shoulder joint function and shoulder joint motion before and after treatment were compared, and the complications of the three groups were recorded. Results Compared with group C, the healing time of fractures in group A and group B was significantly shortened, the neck shaft angle was significantly increased, and the height loss of humeral head was significantly reduced(P<0.05), however, there was no significant difference between group A and group B(P>0.05). Compared with that before operation, the scores of pain, function, exercise limitation and anatomical reduction of the three groups were significantly increased after operation, and the scores in group A and group B were significantly higher than those in group C(P<0.05); but there was no significant difference between group A and group B(P>0.05). Compared with that before operation, the mobility of shoulder flexion, extension, adduction and abduction were significantly increased in the three groups in 1 week after operation, and the mobility in group A and group B were significantly better than group C(P<0.05). The incidence of complications in group A and group B was significantly lower than that in group C(P<0.05), but there was no significant difference between group A and group B(P>0.05). Conclusion Enhanced fixation technique for the treatment of osteoporotic fractures of the proximal tibia caused by ice and snow exercise can significantly promote fracture healing, improve shoulder function and mobility, and have fewer complications, which is beneficial to postoperative recovery.
Objective It is to investigate the applicating effect of enhanced fixation technique on the proximal humeral osteoporotic fracture caused by ice and snow exercise. Methods A total of 65 elderly patients with osteoporosis fractures of the proximal tibia caused by snow and ice or winter ground icing slips were collected and divided into group A(n=26), group B(n=21) and group C(n=18) according to their fixation methods. All the three groups were treated with proximal humeral locking and internal fixation, group A was fixed with calcium phosphate cement, and group B was fixed with allogeneic bone strip, Group C was simply fixed with a locking plate screw. The fracture healing time, postoperative neck shaft angle, humeral head height loss and shoulder joint function and shoulder joint motion before and after treatment were compared, and the complications of the three groups were recorded. Results Compared with group C, the healing time of fractures in group A and group B was significantly shortened, the neck shaft angle was significantly increased, and the height loss of humeral head was significantly reduced(P<0.05), however, there was no significant difference between group A and group B(P>0.05). Compared with that before operation, the scores of pain, function, exercise limitation and anatomical reduction of the three groups were significantly increased after operation, and the scores in group A and group B were significantly higher than those in group C(P<0.05); but there was no significant difference between group A and group B(P>0.05). Compared with that before operation, the mobility of shoulder flexion, extension, adduction and abduction were significantly increased in the three groups in 1 week after operation, and the mobility in group A and group B were significantly better than group C(P<0.05). The incidence of complications in group A and group B was significantly lower than that in group C(P<0.05), but there was no significant difference between group A and group B(P>0.05). Conclusion Enhanced fixation technique for the treatment of osteoporotic fractures of the proximal tibia caused by ice and snow exercise can significantly promote fracture healing, improve shoulder function and mobility, and have fewer complications, which is beneficial to postoperative recovery.
引文
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[10] 潘杨,谭云,许将兴,等.肱骨近端内锁定系统治疗老年肱骨近端复杂骨折33例疗效分析[J].贵州医药,2016,40(8):869-871
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[13] 孙佳佳,杨惠林,周军,等.同种异体骨与自体骨填充椎间融合修复脊髓型颈椎病的比较[J].中国组织工程研究,2015,19(3):329-334
[14] 苏志辉,鲁厚根,刘军,等.同种异体骨移植强化高危人群肱骨近端骨折内固定的疗效观察[J].中国组织工程研究,2016,20(12):1766-1771
[2] 郭伟军,赵友明,王新华,等.锁定钢板治疗肱骨近端骨折内侧柱支撑螺钉数量与其疗效的相关性研究[J].中华骨科杂志,2015,35(1):40-47
[3] 向成浩,王诗波,明玉祥.内侧柱支撑重建结合锁定钢板内固定治疗老年肱骨近端骨折的临床疗效[J].中国矫形外科杂志,2015,23(4):289-294
[4] 黄洁夫.现代外科学[M].北京:人民军医出版社,2003:117-118
[5] 黄志明,李高舜.锁定钢板联合植骨治疗老年肱骨近端骨质疏松性骨折[J].中华手外科杂志,2016,32(5):398-399
[6] 杨勇,樊雅玲,冯敬桃,等.非克氏针改良钢丝张力带内固定治疗髌骨骨折[J].西南医科大学学报,2016,39(2):137-140
[7] 王淑娟,陈丽萍.锁定钢板外固定治疗伴有严重软组织损伤胫骨骨折病人的护理[J].护士进修杂志,2015,30(4):322-323
[8] 郭伟军,赵友明,王新华,等.锁定钢板治疗肱骨近端骨折内侧柱支撑螺钉数量与其疗效的相关性研究[J].中华骨科杂志,2015,35(1):40-47
[9] 覃肖欢.肱骨近端锁定钢板治疗老年肱骨近端骨折愈合及运动功能的影响[J].浙江临床医学,2016,18(10):1870-1871
[10] 潘杨,谭云,许将兴,等.肱骨近端内锁定系统治疗老年肱骨近端复杂骨折33例疗效分析[J].贵州医药,2016,40(8):869-871
[11] Miyamoto Y,Ishikawa K,Takechi M,et al.Tissue response to fast-setting calcium phosphate cement in bone[J].J Biomed Mater Res,2015,37(4):457-464
[12] Xu HH,Quinn JB,Takagi S,et al.Strong and macroporous calcium phosphate cement:Effects of porosity and fiber reinforcement on mechanical properties[J].J Biomed Mater Res,2015,57(3):457-466
[13] 孙佳佳,杨惠林,周军,等.同种异体骨与自体骨填充椎间融合修复脊髓型颈椎病的比较[J].中国组织工程研究,2015,19(3):329-334
[14] 苏志辉,鲁厚根,刘军,等.同种异体骨移植强化高危人群肱骨近端骨折内固定的疗效观察[J].中国组织工程研究,2016,20(12):1766-1771