成人肱骨近端骨折给予肱骨近端锁定钢板治疗的临床分析
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摘要
目的:探讨成人肱骨近端骨折给予肱骨近端锁定钢板(LPHP)治疗的临床效果。方法:选取笔者所在医院2016年1月-2017年8月收治的71例肱骨近端骨折患者,其中陈旧骨折13例,新鲜骨折58例,均实施切开复位LPHP内固定。用简易肩关节测验(SST)问卷、UCLA评分系统、Constant-Murley评分、美国肩肘外科医师评分(ASES)评估总体治疗效果。观察与对比治疗前后临床效果。结果:治疗前患者内旋为T3水平,治疗后内旋达T9水平。治疗后肩关节活动范围、三角肌肌力、VAS评分、Constant-Murley评分、ASES评分及UCLA评分均显著优于治疗前,差异均有统计学意义(P<0.05);75例患者中,1例因麻醉而发生术后气胸,经针对性治疗后,已康复;术后出现晚期并发症8例,其中肱骨头坏死3例,螺钉松动1例,延迟愈合1例,关节退变1例,肱骨干骨折1例,移位骨化1例;患者总满意度为91.55%。结论:在掌握娴的熟操作技术及正确选择手术指征的前提下,运用肱骨近端锁定钢板治疗有显著移位的肱骨近端骨折患者,效果良好,临床应用价值高。
Objective: To investigate the clinical effect of proximal humeral locking plate(LPHP) for the treatment of proximal humeral fractures in adults.Method: A total of 71 patients of proximal humeral fractures treated in the author's hospitalfrom January 2016 to August 2017 were selected,13 cases of old fractures and 58 cases of fresh fractures were performed open reduction and LPHP internal fixation.The shoulder joint test(SST) questionnaire,UCLA scoring system, Constant-Murley score and American Shoulder Elbow surgeon score(ASES) were used to evaluate the overall therapeutic effect.Result:The Internal rotation of patients was T3 before treatment and reached T9 after treatment.After treatment, the range of shoulder motion, the muscle strength of deltoid muscle,the Constant-Murley score, the ASES score and the UCLA score were significantly better than those before treatment,the differences were statistically significant(P<0.05).Among the 75 patients, 1 case developed pneumothorax due to anesthesia and recovered after targeted treatment, and 8 cases had late complications,including 3 cases of humeral head necrosis,1 case of screw loosening, 1 case of delayed healing,1 case of joint degeneration,3 cases of necrosis of brachial head,1 case of screw loosening,1 case of delayed healing and 1 case of joint degeneration.1 case of humeral shaft fracture,1 case of displaced ossification,the total satisfaction rate of patients was 91.55%.Conclusion:Under the premise of mastering the skillful operation technology and choosing the operative indications correctly, the proximal humeral locking plate is applied to treat the proximal humeral fractures with significant displacement. The effect is good and the clinical application value is high.
Objective: To investigate the clinical effect of proximal humeral locking plate(LPHP) for the treatment of proximal humeral fractures in adults.Method: A total of 71 patients of proximal humeral fractures treated in the author's hospitalfrom January 2016 to August 2017 were selected,13 cases of old fractures and 58 cases of fresh fractures were performed open reduction and LPHP internal fixation.The shoulder joint test(SST) questionnaire,UCLA scoring system, Constant-Murley score and American Shoulder Elbow surgeon score(ASES) were used to evaluate the overall therapeutic effect.Result:The Internal rotation of patients was T3 before treatment and reached T9 after treatment.After treatment, the range of shoulder motion, the muscle strength of deltoid muscle,the Constant-Murley score, the ASES score and the UCLA score were significantly better than those before treatment,the differences were statistically significant(P<0.05).Among the 75 patients, 1 case developed pneumothorax due to anesthesia and recovered after targeted treatment, and 8 cases had late complications,including 3 cases of humeral head necrosis,1 case of screw loosening, 1 case of delayed healing,1 case of joint degeneration,3 cases of necrosis of brachial head,1 case of screw loosening,1 case of delayed healing and 1 case of joint degeneration.1 case of humeral shaft fracture,1 case of displaced ossification,the total satisfaction rate of patients was 91.55%.Conclusion:Under the premise of mastering the skillful operation technology and choosing the operative indications correctly, the proximal humeral locking plate is applied to treat the proximal humeral fractures with significant displacement. The effect is good and the clinical application value is high.
引文
[1]杜杰,廖彦生,袁春晓.比较肱骨近端加压锁定钢板与传统钢板治疗肱骨近端骨折的临床疗效[J].中国继续医学教育,2016,26(3):132-133.
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[3]曾浪清,陈云丰,刘燕洁,等.肱骨近端锁定钢板系统治疗成人肱骨近端骨折的疗效分析[J].中华创伤骨科杂志,2016,15(7):624-626.
[4]赵椰枫,王鸥,章恺,等.肱骨近端锁定钢板内固定治疗成人4部分肱骨近端骨折的疗效分析[J].中国骨与关节损伤杂志,2015,30(7):764-765.
[5]王大志,房体刚.采用肱骨近端锁定钢板治疗肱骨近端骨折临床分析[J].工企医刊,2015,26(2):125-126.
[6]崔文飞.肱骨近端锁定钢板治疗肱骨近端骨折的临床疗效分析[J].中国现代药物应用,2016,8(3):61.
[7]赵椰枫,王鸥,章恺,等.肱骨近端锁定钢板内固定治疗成人4部分肱骨近端骨折的疗效分析[J].中国骨与关节损伤杂志,2015,30(7):764-765.
[8]张峰,方锋助,牒军,等.肱骨近端加压锁定钢板治疗肱骨近端骨折的临床研究[J].陕西医学杂志,2016,45(8):1030-1031.
[9]李卫兵,安文秀.肱骨近端加压锁定钢板与传统钢板治疗肱骨近端骨折的临床疗效比较[J].右江民族医学院学报,2016,38(4):391-392.
[10]沈浩.肱骨近端锁定钢板治疗老年肱骨近端骨折的临床效果观察[J].河南医学研究,2015,24(11):79-80.
[11]郭永煜.肱骨近端锁定钢板固定术治疗肱骨近端骨折的疗效观察[J/OL].转化医学电子杂志,2016,3(9):30.
[12]熊春龙,李永清,刘晓英.肱骨近端加压锁定钢板与传统钢板治疗肱骨近端骨折的临床疗效比较[J].蛇志,2016,28(3):309-310.
[13]田伟,侯建文,王玺,等.锁定钢板治疗老年肱骨近端骨折效果观察[J].中国卫生标准管理,2015,6(21):22-23.
[14]张一鸣,彭昊,等.锁定钢板治疗肱骨近端骨折的临床疗效分析[J].生物骨科材料与临床研究,2015,12(5):58-60.
[15]陆伟成,罗振东,张建明,等.锁定钢板结合重建肱骨近端内侧支撑治疗成人肱骨近端骨折[J].生物骨科材料与临床研究,2016,13(6):20-24.
[2]韩红福.肱骨近端锁定钢板治疗老年肱骨近端骨折的临床分析[J].临床医学,2016,36(1):62-64.
[3]曾浪清,陈云丰,刘燕洁,等.肱骨近端锁定钢板系统治疗成人肱骨近端骨折的疗效分析[J].中华创伤骨科杂志,2016,15(7):624-626.
[4]赵椰枫,王鸥,章恺,等.肱骨近端锁定钢板内固定治疗成人4部分肱骨近端骨折的疗效分析[J].中国骨与关节损伤杂志,2015,30(7):764-765.
[5]王大志,房体刚.采用肱骨近端锁定钢板治疗肱骨近端骨折临床分析[J].工企医刊,2015,26(2):125-126.
[6]崔文飞.肱骨近端锁定钢板治疗肱骨近端骨折的临床疗效分析[J].中国现代药物应用,2016,8(3):61.
[7]赵椰枫,王鸥,章恺,等.肱骨近端锁定钢板内固定治疗成人4部分肱骨近端骨折的疗效分析[J].中国骨与关节损伤杂志,2015,30(7):764-765.
[8]张峰,方锋助,牒军,等.肱骨近端加压锁定钢板治疗肱骨近端骨折的临床研究[J].陕西医学杂志,2016,45(8):1030-1031.
[9]李卫兵,安文秀.肱骨近端加压锁定钢板与传统钢板治疗肱骨近端骨折的临床疗效比较[J].右江民族医学院学报,2016,38(4):391-392.
[10]沈浩.肱骨近端锁定钢板治疗老年肱骨近端骨折的临床效果观察[J].河南医学研究,2015,24(11):79-80.
[11]郭永煜.肱骨近端锁定钢板固定术治疗肱骨近端骨折的疗效观察[J/OL].转化医学电子杂志,2016,3(9):30.
[12]熊春龙,李永清,刘晓英.肱骨近端加压锁定钢板与传统钢板治疗肱骨近端骨折的临床疗效比较[J].蛇志,2016,28(3):309-310.
[13]田伟,侯建文,王玺,等.锁定钢板治疗老年肱骨近端骨折效果观察[J].中国卫生标准管理,2015,6(21):22-23.
[14]张一鸣,彭昊,等.锁定钢板治疗肱骨近端骨折的临床疗效分析[J].生物骨科材料与临床研究,2015,12(5):58-60.
[15]陆伟成,罗振东,张建明,等.锁定钢板结合重建肱骨近端内侧支撑治疗成人肱骨近端骨折[J].生物骨科材料与临床研究,2016,13(6):20-24.