摘要
目的探讨解剖钢板内固定治疗复杂肱骨近端骨折伴肱骨干骨折的疗效。方法采用回顾性病例系列研究分析1998年7月-2015年7月收治的58例复杂肱骨近端骨折伴肱骨干骨折患者临床资料，其中男31例，女27例；年龄18～86岁。平均63岁。按Neer分型：三部分骨折42例，四部分骨折16例，其中合并肱骨头压缩性或劈裂骨折4例，伴发肩关节脱位38例。肱骨干骨折按部位分类：上1／3骨折36例，中、下1／3骨折19例，肱骨干多段骨折3例。均应用骨折解剖复位、肱骨近端解剖钢板内固定治疗。观察骨折愈合情况；根据Neer评分系统评定疗效，观察并发症发生情况。结果患者均获随访1～18年，平均8．6年。患者骨折均愈合；愈合时间10～24周，平均14．5周。Neer评分：优23例，良25例，可8例，差2例，优良率为83％。术后无感染，无神经、血管损伤。前屈上举功能受限6例；1例肱骨头部分坏死，应用冲击波治疗；1例切口愈合欠佳，远端渗出血性液3周，经换药治愈。结论解剖钢板内固定治疗复杂肱骨近端骨折伴肱骨干骨折疗效显著，患者功能恢复良好，并发症少。
Objective To investigate the efficacy of anatomic plate internal fixation in treatment of complex proximal humeral fractures combined with humeral shaft fractures. Methods This retrospective case series study included 58 patients with complex proximal humeral fractures combined with humeral shaft fractures admitted from July 1998 to July 2015. There were 31 males and 27 females, with a mean age of 63 years （range, 18-86 years）. According to the Neer classification of proximal humeral fractures, three- part fractures were noted in 42 patients and four-part fractures in 16 patients. Four patients were combined with compressed or splitting fractures of the head of humerus and 38 patients with dislocation of the shoulder. According to the site classification of femoral shaft fractures, proximal 1/3 shaft fractures were noted in 36 patients, middle and distal 1/3 shaft fractures in 19, and muhisegmental shaft fractures in three. All patients underwent anatomic reduction and anatomic plate internal fixation. Bone healing, Neer score of function outcome and complications were evaluated after operation. Results Mean duration of follow-up was 8.6 years （range, 1-18 years）. Bone union was observed in all patients after 10 to24 weeks （mean, 14. 5 weeks）. According to the Neer score, the outcomes were excellent in 23 patients, good in 25, fair in eight and poor in two, with the excellent rate of 83 %. Complications such as infection, nerve injury and vascular injury were not observed after operation. Six patients suffered from limitations of shoulder anterior flexion and rise, one patient had humeral head necrosis and treated by shock wave treatment, and one patient had poor incision healing with hemorrhagic effusion and cured after dressing. Conclusion Anatomic plate internal fixation can contribute to fast functional recovery and few complications in treatment of complex proximal humeral fractures combined with humeral shaft fractures.
出处
《中华创伤杂志》
CSCD
北大核心
2017年第5期408-413,共6页
Chinese Journal of Trauma
关键词
肱骨骨折
骨折固定术
内
复位
Humeral fractures
Fracture fixation, internal
Reduction
