锁定钢板联合异体腓骨移植治疗老年骨质疏松性肱骨近端骨折
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摘要
目的:分析锁定钢板联合异体腓骨移植治疗老年骨质疏松性肱骨近端骨折的临床效果。方法:随机选择我院2016年9月-2017年9月住院的37例老年骨质疏松性肱骨近端骨折,Neer分型为三、四部分骨折,全部采用切开复位,随机行异体腓骨移植及肱骨近端锁定钢板内固定治疗(实验组)及同种异体骨条填充锁定钢板内固定治疗(对照组),搜集术前两组年龄、性别、骨折类型及骨密度值、手术时间和手术出血量、术后两组骨折愈合时间、颈干角、肩关节功能评分等资料。结果:两组在手术时间和出血量上差异无统计学意义。两组无神经血管损伤发生。术后两组X线片检查示骨折对位对线良好。两组伤口无红肿,渗液及感染等,未发现异体骨排斥反应,伤口I/甲级愈合。两组在骨折愈合时间及术后3周、1年颈干角上有统计学差异性。实验组无骨折移位、内固定切割及肱骨头坏死发生。肩关节功能评分:优10例,良5例,中2例,优良率为88.2%。颈干角术后1周为(135.00±3.03)°,术后3周(133.00±1.07)°,术后12个月(132.00±0.98)°。对照组发生骨折移位4例,发生内固定切割2例,肱骨头缺血性坏死2例。骨性愈合时间为(22.61±3.75)周。肩关节功能:优8例,良8例,中2例,差2例;优良率为80. 0%。颈干角术后1周(133.28±4.20)°,术后3周(125.00±6.52)°,术后12个月(120.00±10.01)°。结论:肱骨近端锁定钢板联合异体腓骨移植治疗骨质疏松性肱骨近端骨折疗效满意,具有内固定可靠、骨折愈合率高、术后并发症少、肩关节功能恢复好的特点。
Objective To analyze the clinical effect of locking plate combined with fibula allograft in the treatment of osteoporotic proximal humeral fractures in the elderly.Methods Thirty-seven cases of proximal humerus fracture with osteoporosis were randomly selected from September 2016 to September 2017 in our hospital.They were classified as III or IV degree of partial fracture according to Neer classification.All cases were treated by open reduction,allogenic fibula transplantation and proximal humerus locking plate internal fixation(experimental group) and allogenic bone filling locking plate internal fixation(control group).The data of age,gender,fracture type and bone mineral density,operation time and bleeding,fracture healing time,neck-trunk angle and shoulder joint function score were collected.Results There was no significant difference in the operation time and bleeding volume between the two groups.No neurovascular injury occurred in the two groups.X-ray examination of the two groups showed good alignment of the fracture alignment.There were no redness,exudation and infection in the two groups.No allogeneic bone rejection was observed,and wound was healed at I/A degree.There were statistical differences between the two groups in the time of fracture healing and the 3-week and 1-year cervical trunk angle.There was no fracture displacement,internal fixation cutting and humeral head necrosis in the experimental group.Shoulder joint function score:excellent in 10 cases,good in 5 cases and fine in 2 cases.The excellent and good rate was 88.2%.The cervical trunk angles were(135.00±3.03) ° at 1 week,(133.00±1.07) ° at 3 weeks and(132.00±0.98) °at 12 months after surgery.In the control group,there were 4 cases of fracture displacement.2 cases were fixed and 2 cases were avascular necrosis of the humeral head.The time of bone healing was(22.61±3.75) weeks.Shoulder joint function:excellent in 8 cases,good in 8 cases,fine in 2 cases,poor in 2 cases;excellent and good rate was 80.0%.The cervical trunk angles were(133.28±4.20) ° at 1 week,(125.00±6.52) ° at 3 weeks and(120.00±10.01) ° at 12 months after operation.Conclusions Proximal humerus locking plate combined with allogenic fibula transplantation for the treatment of osteoporotic proximal humerus fracture has satisfactory curative effect.It has reliable internal fixation,high fracture healing rate,fewer complications and good recovery of shoulder joint function.
Objective To analyze the clinical effect of locking plate combined with fibula allograft in the treatment of osteoporotic proximal humeral fractures in the elderly.Methods Thirty-seven cases of proximal humerus fracture with osteoporosis were randomly selected from September 2016 to September 2017 in our hospital.They were classified as III or IV degree of partial fracture according to Neer classification.All cases were treated by open reduction,allogenic fibula transplantation and proximal humerus locking plate internal fixation(experimental group) and allogenic bone filling locking plate internal fixation(control group).The data of age,gender,fracture type and bone mineral density,operation time and bleeding,fracture healing time,neck-trunk angle and shoulder joint function score were collected.Results There was no significant difference in the operation time and bleeding volume between the two groups.No neurovascular injury occurred in the two groups.X-ray examination of the two groups showed good alignment of the fracture alignment.There were no redness,exudation and infection in the two groups.No allogeneic bone rejection was observed,and wound was healed at I/A degree.There were statistical differences between the two groups in the time of fracture healing and the 3-week and 1-year cervical trunk angle.There was no fracture displacement,internal fixation cutting and humeral head necrosis in the experimental group.Shoulder joint function score:excellent in 10 cases,good in 5 cases and fine in 2 cases.The excellent and good rate was 88.2%.The cervical trunk angles were(135.00±3.03) ° at 1 week,(133.00±1.07) ° at 3 weeks and(132.00±0.98) °at 12 months after surgery.In the control group,there were 4 cases of fracture displacement.2 cases were fixed and 2 cases were avascular necrosis of the humeral head.The time of bone healing was(22.61±3.75) weeks.Shoulder joint function:excellent in 8 cases,good in 8 cases,fine in 2 cases,poor in 2 cases;excellent and good rate was 80.0%.The cervical trunk angles were(133.28±4.20) ° at 1 week,(125.00±6.52) ° at 3 weeks and(120.00±10.01) ° at 12 months after operation.Conclusions Proximal humerus locking plate combined with allogenic fibula transplantation for the treatment of osteoporotic proximal humerus fracture has satisfactory curative effect.It has reliable internal fixation,high fracture healing rate,fewer complications and good recovery of shoulder joint function.
引文
[1]梅海龙,王志烈,王军海.锁定钢板联合结构性植骨治疗肱骨近端三四部分骨折[J].湖北医药学院学报,2014,33(3):221-224.
[2]张明,陈云丰,胡海,等.肱骨近端骨折内固定术后螺钉穿出肱骨头的影响因素分析[J].中华创伤骨科杂志,2015,17(4):282-284.
[3]曾浪清,陈云丰,张长青,等.成人肱骨近端骨折锁定钢板固定术中重建肱骨颈干角的临床意义[J].中华骨科杂志,2013,33(2):158-164.
[4]曾浪清,陈云丰.肱骨近端骨折内固定失败危险因素的研究进展[J].中华创伤骨科杂志,2012,14(4):346-348.
[5] Hardeman F,Bollars P,Donnelly M,et al. Predictive factmm for functional outcome and fai Lure in angular stabh osteosynthesis of the proximal humerus[J]. Injury,2012,43:153-158.
[6] Krappinger D,Bizzotto N,Riedmann S,et al.Predicting failure after surgical fixation of proximal humems fractures[J].Injury,2011,42:1 283-1 288.
[7] Clement ND,Duckworth AD,McQueen MM,et al. The outcome of proximal humeral fractures in the elderly:predictors of mortality and function[J]. Bone Joint J,2014,96-B(7):970-977.
[8]刘亚东.肱骨近端骨折的治疗进展[J].湖北医药学院学报,2012,31(5):435-438.
[9]陈孝均,陈红生,邹永根,等.同种异体腓骨移植锁定钢板固定治疗C2型肱骨近端骨折[J].中国修复重建外科杂志,2014,28(2):201-204.
[10]陈立,赵弟庆,杨广忠,等.两种锁定钢板置入内固定治疗老年肱骨近端骨折[J].中国组织工程研究,2013,17(52):9 011-9 016.
[11]钟子云,刘盾.锁定钢板治疗肱骨近端骨折的疗效分析[J].临床和实验医学杂志,2013,12(14):1 149-1 150.
[12]纪忠义,杨震,郑鹏,等.影响锁定钢板内固定治疗肱骨近端骨折术后肩关节功能的相关因素分析[J].中华创伤骨科杂志,2013,15(9):812-813.
[13] Gardner MJ,Boraiah S,Helfet DL,et al.Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant[J]. J Orthop Trauma,2008,22(3):195-200.
[14]金红光,张伟,李海波.吻合血管腓骨近端带关节移植治疗桡骨远端骨巨细胞瘤[J].中华肿瘤杂志,2018,40(11):869-871.
[15]李军.同种异体腓骨移植锁定钢板固定治疗C2型肱骨近端骨折[J].中国实用医刊,2018,45(14):44-46.
[2]张明,陈云丰,胡海,等.肱骨近端骨折内固定术后螺钉穿出肱骨头的影响因素分析[J].中华创伤骨科杂志,2015,17(4):282-284.
[3]曾浪清,陈云丰,张长青,等.成人肱骨近端骨折锁定钢板固定术中重建肱骨颈干角的临床意义[J].中华骨科杂志,2013,33(2):158-164.
[4]曾浪清,陈云丰.肱骨近端骨折内固定失败危险因素的研究进展[J].中华创伤骨科杂志,2012,14(4):346-348.
[5] Hardeman F,Bollars P,Donnelly M,et al. Predictive factmm for functional outcome and fai Lure in angular stabh osteosynthesis of the proximal humerus[J]. Injury,2012,43:153-158.
[6] Krappinger D,Bizzotto N,Riedmann S,et al.Predicting failure after surgical fixation of proximal humems fractures[J].Injury,2011,42:1 283-1 288.
[7] Clement ND,Duckworth AD,McQueen MM,et al. The outcome of proximal humeral fractures in the elderly:predictors of mortality and function[J]. Bone Joint J,2014,96-B(7):970-977.
[8]刘亚东.肱骨近端骨折的治疗进展[J].湖北医药学院学报,2012,31(5):435-438.
[9]陈孝均,陈红生,邹永根,等.同种异体腓骨移植锁定钢板固定治疗C2型肱骨近端骨折[J].中国修复重建外科杂志,2014,28(2):201-204.
[10]陈立,赵弟庆,杨广忠,等.两种锁定钢板置入内固定治疗老年肱骨近端骨折[J].中国组织工程研究,2013,17(52):9 011-9 016.
[11]钟子云,刘盾.锁定钢板治疗肱骨近端骨折的疗效分析[J].临床和实验医学杂志,2013,12(14):1 149-1 150.
[12]纪忠义,杨震,郑鹏,等.影响锁定钢板内固定治疗肱骨近端骨折术后肩关节功能的相关因素分析[J].中华创伤骨科杂志,2013,15(9):812-813.
[13] Gardner MJ,Boraiah S,Helfet DL,et al.Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant[J]. J Orthop Trauma,2008,22(3):195-200.
[14]金红光,张伟,李海波.吻合血管腓骨近端带关节移植治疗桡骨远端骨巨细胞瘤[J].中华肿瘤杂志,2018,40(11):869-871.
[15]李军.同种异体腓骨移植锁定钢板固定治疗C2型肱骨近端骨折[J].中国实用医刊,2018,45(14):44-46.