肱骨近端骨折的手术治疗策略

目的探讨不同类型肱骨近端有移位骨折的最佳手术治疗方案。方法对肱骨近端骨折有移位的174例患者,进行Neer分类,122例二部分骨折和8例三部分骨折行三叶草钢板内固定,30例三部分骨折和3例四部分骨折行肱骨近端加压锁定钢板（10cking proximal hunerus plate,LPHP）内固定,而5例三部分骨折和6例四部分骨折行人工肱骨头置换术（humeral head replacement,HHR）。结果内固定术后所有骨折均愈合,无畸形。愈合时间为8—12周,平均10周。肱骨头置换术后,假体未出现松动、脱位等现象。所有病例均无感染、神经、血管损伤等并发症发生。结论对肱骨近端骨折采用手术治疗可取得较为满意的效果。Neer二部分骨折、多数三部分骨折及一些四部分骨折可采用钢板内固定,而部分三部分骨折、多数四部分骨折可根据情况一期行人工肱骨头置换术。     

经皮微创锁定钢板内固定对老年肱骨近端骨折患者的临床疗效

目的探讨经皮微创锁定钢板内固定(MIPPO)对老年肱骨近端骨折患者疼痛程度及关节功能的影响。方法前瞻性选取2017年6月-2018年6月治疗的肱骨近端骨折患者105例,依据手术方法将其分为MIPPO组(n=55)和传统切开复位组(n=50),MIPPO组患者行微创锁定钢板改良内固定治疗,传统切开复位组患者行传统切开复位内固定治疗,比较两组患者围术期指标、治疗效果、治疗前后VAS评分及不良事件发生情况。结果MIPPO组患者手术时间[(69.1±16.4)min vs.(101.4±30.5)min]、术中出血量[(85.3±24.5)m L vs.(163.5±40.8)m L)]、术后引流量[(18.3±4.6)m L vs.(23.4±5.3)m L]、住院时间[(2.8±0.9)d vs.(4.5±1.0)d],骨折愈合时间[(11.6±2.3)周vs.(16.8±3.5)周],可负重时间[(8.1±2.1)周vs.(9.6±2.0)周]均短(少)于传统切开复位组,差异有统计学意义(P<0.05)。MIPPO组、传统切开复位组患者治疗有效率分别为94.55%、80.00%,MIPPO组优于传统切开复位组(P<0.05)。治疗前两组患者VAS评分比较差异无统计学意义(P>0.05);术后2、4周,MIPPO组患者VAS评分均低于传统切开复位组(P<0.05)。传统切开复位组患者术后3例发生骨折延迟愈合,2例发生外展受限;MIPPO组患者术后1例发生骨折延迟愈合,1例发生外展受限;两组患者不良事件发生率比较差异无统计学意义(10.00%vs.3.64%,χ^2=1.538,P=0.173)。结论微创锁定钢板改良内固定治疗老年肱骨近端骨折治疗效果显著,不增加不良事件发生风险,值得临床推广使用。     

手术治疗肱骨近端骨折108例临床分析

目的：总结肱骨近端骨折手术治疗的临床疗效、适应证及手术体会。方法：对108例有手术指征的肱骨近端骨折患者分别采用螺钉和三叶草钢板或肱骨近端锁定钢板治疗,比较两种手术方式的治疗效果。结果：锁定钢板治疗组的疗效明显优于三叶草钢板组,锁定钢板的优良率90%,三叶草钢板的优良率81%。结论：在治疗肱骨近端骨折时,应根据患者的年龄、骨的质量、骨折类型和部位而选择适当的术式。肱骨外科颈骨折可选用三叶草钢板,三、四部分骨折或肱骨头骨折采用锁定钢板较好。大、小结节骨折可选择螺丝钉固定或结合钢板固定。对于Ⅳ型骨折争取钢板内固定,Ⅱ期肱骨头坏死或明显影响肩关节功能的患者做关节置换手术。     

微创锁定钢板治疗肱骨近端骨折19例临床观察

目的：探讨肩峰下外侧横切口经三角肌入路行肱骨近端锁定钢板内固定治疗肱骨近端骨折的临床效果。方法：采用肩峰下外侧横切口经三角肌入路肱骨近端锁定钢板治疗肱骨近端骨折19例。根据Neer分型：二部分骨折6例,三部分骨折12例,四部分骨折1例。结果：19例均获得随访,随访时间6～18个月,平均10个月,切口均一期愈合。疗效评价采用Neer功能评分优良率为89.5%。结论：肩峰下外侧横切口经三角肌入路行肱骨近端锁定钢板内固定治疗肱骨近端骨折对骨与软组织损伤小,固定牢固可靠,骨折愈合率高,可使患肩早期功能锻炼,避免关节僵硬。对老年患者尤为适用。     

锁定钢板治疗肱骨近端四部分骨折的疗效分析

目的探讨应用锁定加压钢板（locking compression plate,LCP）治疗肱骨近端四部分骨折的疗效。方法 2007年8月～2009年3月,我院共应用锁定加压接骨板治疗肱骨近端四部分骨折12例,均为NeerⅣ型骨折。手术采用三角肌、胸大肌间隙入路。复位后骨折断端如果有骨质缺损,则进行自体或异体骨植入,填补骨缺损。术后1周开始肩关节上举活动,防止肩关节僵硬。结果所有患者术后随访时间9～16月,平均12.5月。所有患者均获骨性愈合,根据Neer功能评价标准,优9例、良2例、一般1例,优良率为91.7%。结论锁定钢板可以充分固定肱骨近端四部分骨折各个骨折块,效果满意,可作为NeerⅣ型骨折的标准治疗方式。     

锁定加压接骨板治疗肱骨近端骨折38例疗效分析

目的探讨应用锁定加压接骨板(LCP)治疗肱骨近端骨折的临床疗效。方法取肩关节前内侧入路,采取切开复位LCP内固定治疗肱骨近端骨折38例,术后早期功能锻炼。结果随访8周～15个月,骨折均骨性愈合,按照Neer评分法评价疗效,肩关节功能恢复优良率92.8%。结论应用LCP治疗肱骨近端骨折高度稳定、微创,可早期进行功能锻炼,肩关节功能恢复良好,是治疗肱骨近端骨折,特别是粉碎骨折的理想方法。     

解剖锁定钢板治疗肱骨近端骨折64例疗效分析

目的:探讨解剖锁定钢板治疗肱骨近端骨折的临床效果.方法:将我院收治的64例肱骨近端骨折患者,随机分为对照组和观察组.对照组采用常规手术治疗,观察组采用解剖锁定钢板治疗.比较两组的治疗效果及不良反应发生情况.结果:观察组手术时间、术中出血量明显少于对照组,差异有统计学意义(P＜0.05).观察组与对照组骨折愈合时间,经统计学分析,差异无统计学意义(P＞0.05).观察组Neer评分优良率显著高于对照组,差异有统计学意义(P＜0.05).结论:采用锁定钢板内固定治疗肱骨近端骨折,手术时间短,术中出血量少,骨折愈合良好,术后功能恢复佳,值得临床推广应用.     

微创经皮钢板内固定治疗肱骨近端骨折

目的 探讨微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术在肱骨近端骨折中的临床应用及随访疗效.方法 2006年12月-2008年9月运用MIPPO技术使用锁定钢板治疗36例肱骨近端骨折患者,其中男23例,女13例.根据AO/OTA分型:A2型4例,A3型10例,B1型5例,B2型11例,C1型3例,C2型3例.经肩前外侧横行或纵行做皮肤切口,纵行分离三角肌,探及骨折,直视下间接和直接复位.经骨表面肌肉下隧道向骨折远端插入锁定钢板,于钢板远端做纵行切口,远近端分别用锁定螺钉固定.术后定期随访,指导功能锻炼,并评定其疗效.结果 手术时间(50.1±11.3)min,出血(76.3±18.7)ml,手术切口(4.5±0.8)cm.36例均获随访12～17个月,平均14个月,所有患者均骨性愈合,愈合时间(10.1±1.2)周.按Neer评分标准,总优良率为86%.结论 利用MIPPO技术治疗肱骨近端骨折安全有效、创伤小、骨愈合时间短,能得到较好的影像学复位,术后疼痛较少.     

Avulsion fracture of the medial humerus epicondyle in young wrestlers

We report 2 cases of an avulsion fracture of the medial humerus epicondyle in teenage wrestlers. Two youngsters (13 and 14 years of age) who both competed in the Danish national championship in wrestling avulsed their medial humerus epicondyle. Both were operated on, and the medial humerus epicondyle was reinserted and fixed. The postoperative results were good, as both patients achieved a normal range of motion. To prevent injuries, we recommended that children who begin to wrestle be taught correct falling techniques. Open reduction and internal fixation of the avulsed medial humerus epicondyle is mandatory to guarantee a good final result without permanent disability, and the early and correct diagnosis k therefore of importance.     

Supracondylar fractures of the humerus: prediction of the cubitus varus deformity with CT

Rotation of the distal fracture fragment in the supracondylar fracture is a contributing factor in the development of the cubitus varus deformity. Computed tomography (CT) is superior to conventional radiography in the assessment of the position of fracture fragments and was used to study 20 patients with supracondylar fractures after reduction. These fractures were followed up with radiography until healed. As determined from CT scans, rotation of the distal fracture fragment of greater than 10 degrees resulted in an abnormal Baumann angle and a cubitus varus deformity in all patients. Use of CT should facilitate the identification of this complication and thus treatment of these fractures and prevention of subsequent deformity.     

Avulsion fracture of the medial collateral ligament association with Segond fracture

The Segond fracture is a tibial avulsion injury of the insertion of the middle third of the lateral capsular ligament that is typically associated with anterior cruciate ligament and meniscal tears. The classically assigned mechanism of injury is a combination of internal rotation and varus stress. We report two cases of Segond fractures that presented with a variant pattern including osseous avulsion injuries of the medial collateral ligament at the femoral origin, anterior cruciate ligament tear, and pivot shift-type osseous contusion pattern, suggesting an alternative mechanism of injury that includes dominant valgus stress and external rotation components. Awareness of this pattern may aid radiologists, surgeons, and sport medicine physicians in the accurate diagnosis of this injury complex and initiation of appropriate treatment in a timely fashion.     

Correlation of medial/lateral rotation of the humerus with glenohumeral translation

OBJECTIVES: To correlate glenohumeral translation in the anterior/posterior direction with medial and lateral rotation of the humerus. In addition, the length of the anterior and posterior component of the glenohumeral capsuloligamentous complex was varied in order to gain insight into the contribution of each component to limiting translation. All measurements were made with the humerus positioned at 90 degrees of abduction and 0 degrees of flexion/ extension. METHODS: Six fresh cadaveric shoulders were used. Each scapula was mounted in a cement pot to rest it in its correct anatomical position. Seven tests were carried out on each shoulder. A series of measurements of translation of the humerus in the anterior direction and posterior direction were taken at 20 degrees intervals of lateral rotation and then at 20 degrees intervals of medial rotation until the limit of lateral or medial rotation had clearly been reached (test 1). The capsuloligamentous complex was then incised and a beaded chain and catches were sutured across the joint to mimic the capsuloligamentous complex at different lengths (tests 2 to 7). RESULTS/CONCLUSIONS: (a) When the glenohumeral capsuloligamentous complex is intact, the humerus translates maximally in the glenoid (between 20 and 30 mm) when the humerus is between 40 degrees and 100 degrees of lateral rotation. (b) As the glenohumeral capsuloligamentous complex increases in length, so does the extent of translation. (c) In medial rotation, the length of the posterior capsule, rather than the length of the anterior capsule, has the greater effect on anterior/posterior translation. (d) In lateral rotation the length of the anterior capsule, rather than the length of the posterior capsule, has the greater effect on anterior/posterior translation. (e) The glenohumeral ligamentous complex acts more as a cuff, enclosing the joint, rather than as a sling, as is commonly thought.     

肱骨近端锁定钢板治疗难复性肱骨近端骨折脱位18例体会

对肱骨近端锁定钢板(locking proximal humerusplate,LPHP)内固定治疗难复性肱骨近端骨折脱位临床资料进行回顾性分析。18例经7~12个月随访,骨折全部愈合。随访期间未发现肱骨头坏死病例。     

性别对老年髋关节骨折患者术后并发症影响的临床研究

目的评估性别对老年髋关节骨折患者术后并发症之间关系。方法选取自2012年1月—2015年1月就诊的髋关节骨折老年患者(65岁)130例,记录其骨折前基础情况、术后并发症以及病死率情况。分析性别之间的差异,采用Logistic回归分析影响并发症发生的可能因素。结果纳入的研究对象中男性40例,女性90例,两组年龄、美国麻醉医师协会标准(ASA)评分、基础疾病等一般情况无统计学差异(P0.05)。术后男性与女性比并发症以心血管疾病(17.5%vs.13.3%,χ~2=5.110,P=0.024)及肺炎(12.5%vs.5.6%,χ~2=6.430,P=0.011)多见,女性与男性相比泌尿系统感染较多(31.1%vs.20.0%,χ~2=4.464,P=0.035)。在术后4个月内男性病死率较女性高(25.0%vs.13.3%,χ~2=5.110,P=0.024)。认知功能障碍是压疮、心血管疾病、肺炎等并发症的危险因素(OR值分别为1.4(95%CI:1.1,1.8)、1.5(95%CI:1.1,1.9)、2.3(95%CI:1.5,3.7)]。结论老年髋关节骨折患者中多伴有基础疾病,男性术后肺部及心血管并发症的发病率以及术后病死率较高。     

高原部队肱骨内上髁骨折36例治疗体会

目的：总结高原地区肱骨内上髁骨折的治疗经验，为高原部队训练伤防治提供参考。方法：对高原36例脓骨内上髁骨折患者根据骨折分型，分别采取手法复位加石膏夹板内固定(轻度)，切开复位加双克氏针或松质骨螺钉内固定(中、重度新鲜骨折)和碎骨片的清除术(陈旧性骨和固定困难的新鲜骨折)进行治疗，并适时进行功能锻炼。结果：除2例肘关节功能轻度受限、1例并发尺神经炎和1例内固定松动外，其余32例功能恢复均较理想。结论：高原环境下，军训致脓骨内上髁骨折手术后外固定必须牢靠，松动外固定物开始功能锻炼的时间必须在2个月以上。     

Injuries of the medial epicondylar ossification center of the humerus.

The complex nature of the ossification centers makes elbow injuries in a child or adolescent difficult to evaluate. The medial epicondylar ossification center is involved in a significant proportion. Injuries vary from simple avulsions to wide displacement with entrapment in the elbow. When entrapment occurs, it may be mistaken for the trochlear ossification center and the true nature of the injury overlooked. Radiographic findings are presented. The anteroposterior view was found to be diagnostic in minimal or marked avulsions of the medial epicondyle because of the characteristic inferior displacement. The anteroposterior view may not always be diagnostic in cases of entrapment of the medial epicondyle; the lateral view is usually diagnostic. In elbow dislocation, the presence and position of the medial epicondyle must be ascertained. Comparison and oblique views are often of value.