肱骨近端解剖锁定钢板治疗不稳定型肱骨外科颈骨折的临床观察
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摘要
目的:观察采用肱骨近端解剖锁定钢板治疗不稳定型肱骨外科颈骨折的临床疗效,以便提高肱骨外科颈骨折的治愈率。
方法:本研究病例来自山东中医药大学附属医院骨科病房自2007年10月至2010年10月手术治疗且均获完整随访的42例肱骨外科颈骨折患者。其中男性17例,女性25例,年龄最大91岁,最小21岁,平均年龄57.2岁,左侧21例,右侧21例。根据Neer分型标准,Ⅱ型16例、Ⅲ型20例、Ⅳ型6例。术前进行临床诊断及影像学评估,确定手术的时机;术中注意软组织及血管神经的保护;术后指导患者进行系统的康复功能锻炼并采取必要的措施预防并发症的发生。术后一年采用Neer肩关节功能评分标准进行评分,观察疗效。
结果:42例患者,优27例,良11例,可3例,差1例,优良率为90.5%。
结论:采用肱骨近端解剖锁定钢板是治疗不稳定型肱骨外科颈骨折较为有效的治疗方法;术中注意仔细操作、术后进行系统的功能锻练对肩关节的功能恢复尤为重要。此种治疗方法值得临床应用及进一步的研究。
Objective: To observe the clinical curative effect on treating unstable type humerus surgical neck fractures with Proximal humeral anatomy of locking plates therapy, so we can improve the Cure rate of Humerus surgical neck fractures.
Methods: We get 42 patients (17 male and 25 female, the oldest is 91 years and the youngest is 21, with average age 57.2) with unstable type humerus surgical neck fractures. The cases were all got surgical treatments (21 cases are from left side and 21 are from right side) and Postoperative follow-up from the orthopedics department of the affiliated hospital of Shandong traditional medicine university, from October 2007 to October 2010. According to the standard of Neer classification, these cases contain 16 cases for the second type, 20 cases for the third type, 6 cases for the fourth type. Before surgery, we made clinical and imaging evaluation, make sure the surgery opportunity. During the operation, we paid more attention for protecting the Soft tissue and Vessels and nerves. After surgery, we gave the Rehabilitation functional exercises and took necessary measures to prevent the complications. We used Neer Rating criteria shoulder function standard of grading to get the score and observe the Curative rate.
Results: 42 cases were followed up, excellent in 27, good in 11, fair in3, and poor in 1, 90.5%excellent or good results were obtained.
Conclusion: Treating unstable type humerus surgical neck fractures with Proximal humeral anatomy of locking plate therapy is more effective treatment. During the operation, we should operate carefully. And we should give the patients systematic postoperative function training. Both of them are particularly important for the restoration of joint function. This therapy is worthy of clinical application and further research.
方法:本研究病例来自山东中医药大学附属医院骨科病房自2007年10月至2010年10月手术治疗且均获完整随访的42例肱骨外科颈骨折患者。其中男性17例,女性25例,年龄最大91岁,最小21岁,平均年龄57.2岁,左侧21例,右侧21例。根据Neer分型标准,Ⅱ型16例、Ⅲ型20例、Ⅳ型6例。术前进行临床诊断及影像学评估,确定手术的时机;术中注意软组织及血管神经的保护;术后指导患者进行系统的康复功能锻炼并采取必要的措施预防并发症的发生。术后一年采用Neer肩关节功能评分标准进行评分,观察疗效。
结果:42例患者,优27例,良11例,可3例,差1例,优良率为90.5%。
结论:采用肱骨近端解剖锁定钢板是治疗不稳定型肱骨外科颈骨折较为有效的治疗方法;术中注意仔细操作、术后进行系统的功能锻练对肩关节的功能恢复尤为重要。此种治疗方法值得临床应用及进一步的研究。
Objective: To observe the clinical curative effect on treating unstable type humerus surgical neck fractures with Proximal humeral anatomy of locking plates therapy, so we can improve the Cure rate of Humerus surgical neck fractures.
Methods: We get 42 patients (17 male and 25 female, the oldest is 91 years and the youngest is 21, with average age 57.2) with unstable type humerus surgical neck fractures. The cases were all got surgical treatments (21 cases are from left side and 21 are from right side) and Postoperative follow-up from the orthopedics department of the affiliated hospital of Shandong traditional medicine university, from October 2007 to October 2010. According to the standard of Neer classification, these cases contain 16 cases for the second type, 20 cases for the third type, 6 cases for the fourth type. Before surgery, we made clinical and imaging evaluation, make sure the surgery opportunity. During the operation, we paid more attention for protecting the Soft tissue and Vessels and nerves. After surgery, we gave the Rehabilitation functional exercises and took necessary measures to prevent the complications. We used Neer Rating criteria shoulder function standard of grading to get the score and observe the Curative rate.
Results: 42 cases were followed up, excellent in 27, good in 11, fair in3, and poor in 1, 90.5%excellent or good results were obtained.
Conclusion: Treating unstable type humerus surgical neck fractures with Proximal humeral anatomy of locking plate therapy is more effective treatment. During the operation, we should operate carefully. And we should give the patients systematic postoperative function training. Both of them are particularly important for the restoration of joint function. This therapy is worthy of clinical application and further research.
引文
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[21] Prakash U , McGurty DW ,Dent JA Hemiarthroplasty for severe fractures of the proximal humerus [J] . J Shoulder Elbow Surg , 2002, 11(5): 4282430.
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[24]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第三版.北京:人民军医出版社,2005:402-406.
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[3] Ken yamaguchi,William D, Midleton, et al. The demographic and morphological features of rotator cuff disease : a comparison of a symptomatic and symptomatic shoulder[J].JBJS,2006,88:1699-1704.
[4]陆裕朴.实用骨科学[M].北京:人民军医出版社,1996:567.
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[2]张力,祁磊,侯勇,等.交锁髓内钉治疗肱骨近端骨折[J].中华创伤骨科杂志,2007,13(1):81 82.
[3]林伯文,肖德明,徐忠世,等.锁定接骨板治疗老年肱骨近端骨折.中华创伤骨科杂志,2005,7(9):823-825.
[4]林健,云才.肱骨近端解剖型钢板治疗肱骨外科颈骨折32例分析[J].当代医学,2008,14(23):77-78.
[5]覃海宁,夏奎.解剖钢板内固定治疗肱骨外科颈骨折[J].临床骨科杂志,2008,11(5):480.
[6]王亦璁.骨与关节损伤[M].北京:人民卫生出版社,2001:4
[7] Neer CS 2nd Dispiaced proximal humeral fractures,II.Treat2,ment of three-part and four-part displacement J Bone JointSurg Am,1970, 52: 1090-1103.
[8] Neet CS II, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. JBJS, 1982,64: 319-337.
[9]王冠军,张春才,许硕贵.肱骨近端骨折的治疗进展[J].国外医学骨科学分册,2004,25(4):216 218.
[10]王亦璁.骨与关节损伤[M].第四版.北京:人民卫生出版社,2007:756
[11]邱红明.创伤性肱骨头下移症.中国骨伤杂志,1995,8(3):19
[12]荣国威,翟桂华.骨科内固定[M].第3版.北京:人民卫生出版社,2000:2.
[13]陆裕朴.实用骨科学[M].北京:人民军医出版社,1996:567.
[14]涂宏.手拉足蹬法整复肱骨外科颈骨折.中国骨伤,2000,13(1):47.
[15]潘能富.前屈过顶法整复治疗老年性肱骨外科颈骨折.中国正骨,2002,14(12):39.
[16]刘俊杰,赵俊.现代麻醉学[M].北京.人民卫生出版社,1997.
[17]庄心良,曾因明,陈伯銮.现代麻醉学[M].第3版.北京人民卫生出版社,2003:1052 1061.
[18] Wanner GA,Wanner Schmid E,Romero J,et al.Internal fixation of displaced proximal humeral fractures with two one third tubular plates[J].Trauma,2003,54(3):536 544.
[19]周蔚,罗从风,翟伟韬,等.锁定钢板治疗肱骨近端骨折疗效分析[J].中国骨与关节损伤杂志,2006:21(1), 1-3.
[20] Gibson JN, Handoll HH, Madhok R. Interventions for treating proximal humeral fractures in adults [ J ] . Cochrane Database Syst Rev, 2002,2:430-434.
[21] Prakash U , McGurty DW ,Dent JA Hemiarthroplasty for severe fractures of the proximal humerus [J] . J Shoulder Elbow Surg , 2002, 11(5): 4282430.
[22] Lill H,Hepp P,Rose T,et al. The angle stable locking proximal humerus plate (LPHP) for proximal humeral fractures using a small anterior lateral del toid splitting approach technique and first results[J]. Zentralbl Chir,2004,129(1):43 48.〖1〗
[23]巫伟东,詹伟彦,何开正.锁定钢板治疗肱骨近端复杂骨折.中国矫形外科杂志,2003,11(22):1526-1528.
[24]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第三版.北京:人民军医出版社,2005:402-406.
[1] Kannus P. Niemi S, Parkarri J , et al. Why is the age-standarlized incidence of low-trauma fractures rising in many elderly population? J Bone Miner Res,2002,7:1363-67.
[2] Richard W , Nyffeler , clement HL ,et al. Association of a larger lateral extension of ac ormion with rotator cuff tears[J].JBJS,2006,88:800-805.
[3] Ken yamaguchi,William D, Midleton, et al. The demographic and morphological features of rotator cuff disease : a comparison of a symptomatic and symptomatic shoulder[J].JBJS,2006,88:1699-1704.
[4]陆裕朴.实用骨科学[M].北京:人民军医出版社,1996:567.
[5] Neer CS 2nd Dispiaced proximal humeral fractures,II.Treat2,ment of three-part and four-part displacement J Bone JointSurg Am,1970, 52: 1090-1103.
[6] Antuna SA, sperling JW, Sanchez SJ, et al. Shouder arthroplasty for proximal humeral malunions long-term results[J].J Shouder Elbow Surg,2002,11(2):122-129.
[7]王亦璁.骨与关节损伤[M].第4版.北京:人民卫生出版社,2007:763- 764.
[8]姜春岩,耿向苏,王满宜,等.复杂肱骨近端骨折人工肩关节置换术后的若干问题[J].中华外科杂志,2002,40(1):65-67.
[9]孙兆军,杨学章.带锁髓内钉治疗复杂股骨骨折15例疗效观察[J].中国现代医生,2007,45(8):41-42.
[10]张燕青,黄仕光,吴利民.锁定钢板治疗老年肱骨近端骨折[J].中国现代医生,2008,46(20):8.
[11] Ruchholtz S , Nast Kolb D. Humeral head fracture [ J ] .Unfall chirurg,2003,106(6):498-512.
[12]陈禹蒙,陈磊,陈新国.单一手法整合宽布带外固定治疗肱骨外科颈外展型骨折38例临床分析.中华中西医杂志,2007,8(11):14.
[13]王学荣.俯卧位整复法治疗肱骨外科颈骨折.中医正骨,2001,11(13):4.
[14]杨隆奎.折顶手法治疗肱骨外科颈骨折.四川中医, 1996,(14):2.
[15]越学寨,李盛体.皮牵甩肩法配合中药治疗老年肱骨外科颈骨折45例.甘肃中医学院学报, 2006,23(1):6.
[16]常行德,姜文军.手牵足蹬法复位肱骨外科颈骨折30例.骨与关节损伤杂志, 1994,9(4):258-259.
[17]孙全顺,吴启美,梁冠荣,等.牵引回旋法整复肱骨外科颈骨折.中医正骨1999;11(10):2.
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