内固定治疗肱骨近端骨折76例

目的分析不同类型肱骨近端骨折使用不同内固定方法的疗效。方法回顾自1999年1月至2007年6月共治疗的76例肱骨近端骨折。对46例NeerⅡ型骨折,使用克氏针内固定18例,使用空心螺钉内固定28例;对21例NeerⅢ型骨折使用克氏针及螺钉内固定8例,T型钢板固定9例,三叶草型钢板固定4例;对9例NeerⅣ型使用克氏针、螺钉及钢板联合固定。结果76例骨折均骨性愈合,无肱骨头坏死病例。结论肱骨近端骨折应根据不同骨折类型选择不同的内固定治疗方法。     

内固定治疗32例肱骨近端骨折的回顾性分析

目的探讨肱骨近端骨折不同内固定方法的疗效。方法回顾性分析自2000年1月~2005年8月,共治疗的32例肱骨近端骨折。对17例NeerⅡ型骨折,采用克氏针固定6例,空心螺钉固定11例;对10例NeerⅢ型骨折,采用克氏针及螺钉固定6例,T型钢板固定3例,三叶草型钢板固定1例;对5例NeerⅣ型,均采用克氏针、螺钉及钢板联合固定。结果32例均骨性愈合,无肱骨头坏死病例。结论肱骨近端骨折的治疗应根据不同的情况选择不同的内固定方式。     

加压空心螺纹针治疗肱骨近端骨折的生物力学研究

目的探讨加压空心螺纹针治疗肱骨近端骨折固定的生物力学性能,为临床提供基础理论依据。方法采集10具较为新鲜湿润肱骨标本,造成肱骨近端骨折,采用加压空心螺纹针三角平行式穿针固定(A)、加压空心螺纹针交叉固定(B)和常规克氏针交叉固定(C)等3组固定方式,分别行生物力学实验应力分析,分析比较各组生物力学性能的优劣。结果生物力学试验结果表明:(1)3组肱骨近端骨折内固定的压缩强度和刚度、弯曲强度和刚度、扭转强度和刚度和剪切强度和刚度,加压空心螺纹针的交叉固定与三角平行式穿针固定无显著性差异(P0.05),但后者力学性能上略占优势;与克氏针交叉固定相比,A、B两组的生物力学性能明显优与C组,其差别具有统计学显著性(P0.05);(2)加压空心螺纹针的抗拔力远高于克氏针固定,统计呈显著性差异(P0.05)。结论加压空心螺纹针治疗肱骨近端骨折的生物力学性能相当优越,交叉固定与三角平行式穿针固定相媲美,当然后者也是一种不错的选择,而采用克氏针内固定的生物力学性能却比较差,易引起松动、退针、转动等并发症,易导致固定失效。试验结果证明,加压空心螺纹钉具有较好的骨折端间加压作用和抗拔力,促进骨折端愈合,有效防止松动、退针和旋转,维持骨折断端稳定性,且满足早期功能练习,微创、有效恢复肩关节功能。     

肱骨近端骨折的手术治疗

目的探讨肱骨近端二、三部份骨折的治疗方法。方法手术治疗肱骨外科颈骨折38例,按Neer分类标准分型：二部分骨折27例,三部分骨折11例。分3组：A组lO例行普通T形钢板内固定;B组22例行三叶草钢板内固定;C组6例行克氏针或钢丝内固定。结果27例获随访3～12个月。除1例陈旧性骨折延迟愈合外,其余均愈合,愈合时间3～12个月,无感染、内固定断裂等发生。根据Neer肩关节功能评分标准,T形钢板组平均81．2分,三叶草钢板固定组平均86．3分,克氏针固定组平均78．1分。结论明显移位的肱骨近端二、三部分骨折的治疗以钢板螺钉尤其是三叶草型钢板螺钉内固定,能提供更为坚强的固定,术后功能较好。     

老年人肱骨近端粉碎性骨折的外科治疗

[目的] 比较老年人肱骨近端粉碎性骨折内固定方法，评价“三叶草”型钛钢板内固定结合植骨的治疗效果。[方法] 对47例老年人肱骨近端粉碎性骨折患者分别应用克氏针、螺钉内固定和“三叶草”型钛钢板内固定结合植骨术(自体骨、金世植骨灵)治疗。42例得到随访，平均随访时间2．4a，采用Neer分型和评定标准分析疗效。[结果]钢板内固定、植骨术组全部4个月内骨折愈合，克氏针、螺钉内固定术组7例骨不连；32例(32／42)术后肩关节不同程度僵硬。Neer 3、4部骨折(18例)应用克氏针螺钉内固定，优良率为38．4％和20％；“三叶草”型钛钢板 植骨(24例)，优良率为77．7％和50％。[结论]老年人肱骨近端粉碎性骨折，其主要病理变化是骨质疏松和骨折部位骨缺损，宜早期手术治疗。与克氏针、螺钉内固定方法比较，“三叶草”型钛钢板独特的韧性和构型，其近端“筛孔”任意角度穿钉的锚固作用符合AO内固定原则，同时植骨促进骨愈合，是老年肱骨近端粉碎性骨折有效治疗方法。     

闭合复位空心钉与T型钢板治疗复杂肱骨近端骨折的疗效比较

目的比较闭合复位加压空心螺纹钉与T型钢板治疗复杂肱骨近端骨折的疗效。方法2003年6月～2006年7月收治40例三、四部分肱骨近端骨折,闭合复位加压空心螺纹钉与T型钢板治疗各20例,采用Neer骨折分类及评分标准进行手术疗效的评价。结果本组均得到随访,闭合复位加压空心螺纹钉治疗的疗效明显优于T型钢板固定治疗。结论闭合复位加压空心螺纹钉是治疗复杂肱骨近端骨折的一种微创、简单、有效的方法。     

经皮克氏针与锁定钢板治疗肱骨近端骨折的临床研究

目的观察肱骨近端骨折接受经皮克氏针手法复位联合锁定钢板内固定治疗的临床效果。方法 60例肱骨近端骨折患者根据治疗方法不同,分为对照组(克氏针内固定治疗)、观察组(克氏针+锁定钢板内固定治疗)。比较两组的治疗效果,肩关节功能、并发症情况。结果观察组治疗效果优良率、Neer评分优良率高于对照组(P0.05)。两组随访过程中钢板松动、肱骨头坏死、髓内钉退钉、切口感染等并发症发生率比较,差异无显著性(P0.05)。结论克氏针+锁定钢板内固定治疗肱骨近端骨折,临床效果满意,肩关节功能恢复顺利,并发症发生率低。     

张力带缝合结合钢板内固定治疗复杂的肱骨近端骨折

<正>肱骨近端骨折的手术固定方法很多,有经皮或切开复位克氏针固定,张力带钢丝内固定,T形钢板、三叶草钢板或肱骨近端解剖钢板内固定等,特别是近年来较广泛地采用肱骨近端锁定钢板(locking proximal humerus plate,LPHP)使很多复杂的骨折得到有效的固定。笔者自2001年5月至2008年2月采用张力带缝合技术结合钢板内固定治疗复杂的肱骨近端骨折32例,取得了满意的疗效,报告如下。     

老年人肱骨近端粉碎性骨折治疗的临床研究

目的：比较老年人肱骨近端粉碎性骨折内固定方法,评价“三叶草”型钛钢板内固定结合植骨的治疗效果。方法：对37例老年人肱骨近端粉碎性骨折患者分别应用克氏针、螺钉内固定和“三叶草”型钛钢板内固定结合植骨术（自体骨）治疗。31例得到随访,平均随访时间2．4a,采用Neer分型和评定标准分析疗效。结果：钢板内固定、植骨术组全部4个月内骨折愈合,克氏针、螺钉内固定术组7例骨不连;32例（32／42）术后肩关节不同程度僵硬。Neer3、4部骨折（18例）应用克氏针螺钉内固定,优良率为38．4％和20％;“三叶草”型钛钢板＋植骨（24例）,优良率为77．7％和50％。结论：老年肱骨近端粉碎性骨折,其主要病理变化是骨质疏松和骨折部位骨缺损,宜早期手术治疗。与克氏针、螺钉内固定方法比较,“三叶草”型钛钢板独特的韧性和构型,其近端“筛孔”任意角度穿钉的锚固作用符合AO内固定原则,同时植骨促进愈合,是老年肱骨近端粉碎性骨折有效治疗方法。     

交锁髓内钉治疗肱骨近端骨折

肱骨近端骨折是临床上常见的骨折,其手术治疗可采用克氏针、张力带钢丝、螺钉、T形钢板及新型肱骨近端锁定钢板等多种内固定方法。手术治疗可能发生肩关节功能障碍和肱骨头缺血性坏死等并发症。我院自2002年以来采用肱骨近端交锁髓内钉治疗15例肱骨近端骨折患者,取得了良好疗效。     

Fixation of three-part proximal humeral fractures: a biomechanical evaluation

OBJECTIVES: To examine the biomechanical stability of three constructs currently used for the management of three-part proximal humerus fractures. Tension band wires (TBW) with supplemental Enders nails, modified cloverleaf plate and screws, and intramedullary (IM) nailing with proximal and distal interlocks were tested to determine relative stability. DESIGN: A reproducible three-part fracture was made in fresh-frozen stripped proximal humeri. The fracture was stabilized using TBW/Enders nail (n = 6), plate/screws (n = 5), or IM nailing (n = 5). MAIN OUTCOME MEASUREMENTS: Mechanical testing was performed with a small preload followed by deflection of five millimeters at a rate of one millimeter per second in flexion, extension, and varus and valgus relative to the humeral shaft. A load-displacement curve was obtained. Torsional testing was performed in internal and external rotation, and torque-rotation curves were recorded. RESULTS: In cantilever bending, the plate/screws construct and the IM nail construct were superior to the TBW/Enders nail construct for all parameters except extension. There was no statistically significant difference between the IM nail and the plate/screws groups. Torsional stiffness testing revealed that the plate/screws and the IM nail were superior to the TBW/Enders nail construct. There was no statistical difference between the IM nail and the plate/screws groups. CONCLUSIONS: In a cadaveric model of three-part proximal humerus fractures stripped of soft tissue, plate/screws fixation and IM nailing provide greater torsional and bending stiffness than does fixation with TBW/Enders nail. There was no statistically significant difference in torsional or bending stiffness between IM nailing with interlocks and plate/screws fixation in this model.     

Biomechanical evaluation of proximal humeral fracture fixation supplemented with calcium phosphate cement

BACKGROUND: Proximal humeral fractures are common injuries, and numerous surgical methods have been described for their treatment. The biomechanical characteristics of various internal fixation devices that are used to treat these fractures have not been extensively studied, nor has the potential beneficial effect of calcium phosphate cement supplementation. METHODS: We used a cadaveric three-part proximal humeral osteotomy model to perform a biomechanical evaluation of three types of internal fixation devices: a cloverleaf plate, an angled blade-plate, and Kirschner wires. The effect of supplementing the fixation with SRS (Skeletal Repair System) calcium phosphate cement was evaluated as well. Eighteen pairs of fresh-frozen humeri were obtained, and the bone-mineral density of each specimen was measured. In each pair, one specimen was secured with internal fixation alone and the contralateral specimen was secured with internal fixation combined with calcium phosphate cement. The specimens were tested cyclically in abduction and in external rotation for 250 cycles to evaluate interfragmentary motion. The specimens were then loaded to failure in external rotation to measure torsional load to failure and torsional stiffness. RESULTS: Overall, there were no significant differences between the specimens treated with the blade and cloverleaf plates, whereas the specimens treated with Kirschner wires demonstrated more interfragmentary motion, less stiffness, and lower torque to failure. In general, supplementation with calcium phosphate cement led to significant improvements in the mechanical performance of all three forms of internal fixation as demonstrated by a significant decrease in interfragmentary motion, a significant increase in torque to failure, and a significant increase in torsional stiffness. The addition of calcium phosphate cement increased the stiffness of even the most osteoporotic specimens to levels that were higher than those of the most osteodense specimens that had been treated with internal fixation alone. CONCLUSION: The initial biomechanical properties of internal fixation as measured with use of a proximal humeral osteotomy model and three methods of fixation were significantly improved by the addition of calcium phosphate cement.     

Biomechanical analysis of plate osteosynthesis systems for proximal humerus fractures

OBJECTIVES: To biomechanically assess five proximal, humeral, fracture-plate-fixation systems. METHODS: Surgical neck fractures, with and without cortical contact, were created in 25 fresh-frozen cadaveric humeri. Five methods of plate fixation were used for repair: construct A [an eight-hole, low contact dynamic compression (LCDC) plate contoured into a blade shape, supported by one, 70-mm-long, 4.5-mm-diameter cortical screw acting as a truss], construct B (a 10-hole LCDC plate arrangement identical to construct A, but using one, 70-mm-long, 3.5-mm-diameter cortical screw as a truss), construct C [a five-hole dynamic compression (DC) blade plate with one, 6.5-mm-diameter cancellous screw], construct D (a five-hole T-plate supported by three, 6.5-mm-diameter cancellous screws), and construct E (a five-hole cloverleaf plate supported by five, 4-mm-diameter cancellous screws). Plates were posterior to the bicipital groove, 10 mm distal to the greater tuberosity tip, on the lateral aspect of the humeral shaft. Screw fixation was done using standard AO compression plating techniques. Stiffness of constructs was measured in bending and axial compression. Locked plates were not assessed. RESULTS: For cortical contact [abduction of 20 degrees (P=0.02), flexion of 20 degrees (P=0.02), flexion of 90 degrees (P=0.005)] and no cortical contact [flexion of 90 degrees (P=0.0001)], construct A was significantly stiffer than other constructs. For no cortical contact in abduction of 90 degrees (P=0.05), construct A was significantly stiffer than other constructs. CONCLUSIONS: Construct A was significantly stiffer than other constructs.     

骨质疏松性肱骨近端骨折PMMA骨水泥强化螺钉钢板固定的有限元分析

目的：借助有限元分析的方法探讨肱骨近端聚甲基丙烯酸甲酯（polymethyl methacrylate,PMMA）骨水泥强化螺钉钢板固定对骨质疏松性肱骨近端骨折内固定稳定性的影响。方法：制作肱骨近端2部分骨折伴干骺端骨缺损的不稳定肱骨近端骨折数字化模型,分别建立肱骨近端骨水泥强化螺钉钢板固定及普通螺钉钢板固定的有限元模型,分析螺钉周围松质骨应力、整体刚度、钢板最大应力及螺钉最大应力。结果：肱骨近端骨水泥强化螺钉钢板固定的头端6枚螺钉周围松质骨最大应力分别为：1号钉1.07 MPa,2号钉0.43 MPa,3号钉1.16 MPa,4号钉0.34 MPa,5号钉1.99 MPa,6号钉1.57 MPa,普通螺钉钢板固定为：1号钉2.68 MPa,2号钉0.67 MPa,3号钉4.37 MPa,4号钉0.75 MPa,5号钉3.30 MPa、6号钉2.47 MPa。两组模型的整体刚度分别为：骨水泥结构448 N/mm、普通结构434 N/mm。钢板的最大应力均出现在结合孔：骨水泥结构701 MPa、普通结构420 MPa。螺钉的最大应力均出现在4号钉的尾端：骨水泥结构284 MPa、普通结构...     

Calcar screw position in proximal humerus fracture fixation: Don’t miss high!

IntroductionIn locked plate fixation of proximal humerus fractures, the calcar is an important anchor point for screws providing much-needed medial column support. Most locking plate implants utilize a fixed-trajectory locking screw to achieve this goal. Consequently, adjustments of plate location to account for patient-specific anatomy may result in a screw position outside of the calcar. To date, little is known about the consequences of “missing” the calcar during plate positioning. This study sought to characterize the biomechanics associated with proximal and distal placement of locking plates in a two-part fracture model.Materials and methodsThis experiment was performed twice, first with elderly cadaveric specimens and again with osteoporotic sawbones. Two-part fractures were simulated and specimens were divided to represent proximal, neutral, and distal plate placements. Non-destructive torsional and axial compression tests were performed prior to an axial fatigue test and a ramp to failure. Torsional stiffness, axial stiffness, humeral head displacement and stiffness during fatigue testing, and ultimate load were compared between groups.ResultsCadavers: Proximal implant placement led to trends of decreased mechanical properties, but there were no significant differences found between groups. Sawbones: Distal placement increased torsional stiffness in both directions (p = 0.003, p = 0.034) and axial stiffness (p = 0.018) when compared to proximal placement. Distal placement also increased torsional stiffness in external rotation (p = 0.020), increased axial stiffness (p = 0.024), decreased humeral head displacement during fatigue testing, and increased stiffness during fatigue testing when compared to neutral placement.DiscussionThe distal and neutral groups had similar mechanical properties in many cadaveric comparisons while the proximal group trended towards decreased construct stiffness.Resultsfrom the Sawbones model were more definitive and provided further evidence that proximal calcar screw placements are undesirable and distal implant placement may provide improved construct stability.ConclusionSuccessful proximal humerus fracture reconstruction is inherent upon anatomic fracture reduction coupled with medial column support. Results from this experiment suggest that missing the calcar proximally is deleterious to fixation strength, while it is safe, and perhaps even desirable, to aim slightly distal to the intended target.     

Schuhli augmentation of plate and screw fixation for humeral shaft fractures: a laboratory study

OBJECTIVES: Schuhli locking nuts provide a mechanism to lock 4.5-millimeter bone screws to a standard dynamic compression plate (DCP plate). It has been proposed that Schuhlis can provide increased fixation stability in areas of a proximal cortical defect or osteopenic bone and may keep screws from loosening and backing out from the plate. A biomechanical study was performed to investigate the effect of Schuhli augmentation of a ten-hole broad DCP plate for fixation of a simulated humeral shaft fracture versus standard DCP plate fixation. DESIGN: Biomechanical cadaver study. INTERVENTION: Six pairs of cadaveric humeri from elderly individuals were tested in offset axial loading, torsion, and four-point bending to obtain load versus deformation curves and baseline mechanical properties. Each pair of humeri was then instrumented with a ten-hole broad DCP plate on one side and a DCP plate augmented with Schuhlis at each screw hole on the contralateral side. All screws were placed in cortical bone. The constructs were retested in all three modalities. The humeri were then cycled in torsion for 1,000 cycles and retested in all three modalities. Each humerus was then loaded to failure in torsion to determine the ultimate load and rotational displacement. MAIN OUTCOME MEASUREMENTS: Resistance to displacement was determined from the load versus deformation curves in each testing modality before and after cycling; these data were normalized to the intact values determined prior to instrumentation. Paired Student's t tests were performed to determine statistically significant differences between the two modes of fixation. RESULTS: There were no significant differences in stability between the two fixation techniques in all three testing modalities both before and after cycling. However, the Schuhli augmented constructs sustained significantly greater loads and rotational deformations prior to failure. CONCLUSIONS: In this model of humeral shaft fractures in the elderly, the addition of Schuhlis did not significantly change the mechanical stability of plate and screw fixation. However, load and angular deformation at failure were significantly greater in the Schuhli augmented specimens.     

肱骨干骨折内固定的选择及应注意的问题

目的正确选择肱骨干骨折手术内固定.方法对107例肱骨干骨折分别进行交锁髓内钉(34例)、加压钢板(29例)、Y型钢板(38例)、螺钉(6例)等内固定,并随访比较分析. 结果所有病例均得到随访,平均随访6.3个月.交锁髓内钉、螺钉内固定组全部愈合;加压钢板内固定组愈合26例,伴桡神经损伤2例;Y型钢板内固定组全部愈合,伴肘关节僵硬2例. 结论根据肱骨干骨折的部位和类型选用适当的内固定方法,骨折愈合良好,可有效的减少并发症的发生.     

Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation

BACKGROUND: Internal fixation of proximal humeral fractures is associated with a considerable secondary malalignment rate. Fixed-angle implants have been suggested to increase the stability of fixation. METHODS: The biomechanical properties of four different implants were tested. These included an internal fixator with semi-elastic properties (reference), the Synthes T-plate, a locked plate with rigid properties and a spiral blade locked intramedullary nail (PHN). These implants were assessed in twenty-four osteotomized pairs of human cadaveric humeri. Specimens were subjected to two-hundred cycles of axial loading and torque followed by load to failure. RESULTS: The PHN had greater axial stiffness than the reference and the T-plate. During torque, all implants were stiffer than the reference. During cyclic loading, there were no differences between the T-plate and the reference. Both the rigid internal fixator and the PHN had less irreversible deformation than the reference. Both implants resisted higher loads before failure. CONCLUSION: This study showed that the proximal humeral nail and the rigid internal fixator are stronger than the semi-elastic locked plate and the Synthes T-plate for unstable subcapital proximal humeral fractures.     

Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques

OBJECTIVE: Femoral neck fractures in young individuals are typically high angled shear fractures. These injuries are difficult to stabilize due to a strong varus displacement force across the hip with weight bearing. The purpose of this study was to compare the biomechanical stability of four differing fixation techniques for stabilizing vertical shear femoral neck fractures. METHODS: Vertical femoral neck fracture stability was assessed using 4 surgical constructs in 32 cadaveric femurs: 7.3 mm cannulated screws placed in a triangular configuration (group 1), a 135-degree dynamic hip screw (group 2), a 95-degree dynamic condylar screw (group 3), and a locking proximal femoral plate (group 4). The 4 groups were matched for mean bone density and each specimen was tested under incremental loading, cyclical loading, and loading to failure. The modes of fixation failure were recorded for each specimen and the mean group stiffness, failure loads, and failure energies were calculated. RESULTS: All 8 specimens failed during incremental loading in group 1. Five of 8 constructs failed with incremental loading, and 3 failed with cyclical testing in group 2. The combined 16 specimens in groups 3 and 4 survived both incremental and cyclical loading. The differences in stiffness, failure loads, and failure energies between the 4 groups were statistically significant (P < 0.001). The strongest construct was the locking plate and the weakest construct was the 7.3-mm cannulated screw configuration. The cannulated screw configuration group failed as the screws backed out of the femoral head and by varus collapse of the osteotomy; the fixed angled devices all failed at the bone-implant interface. CONCLUSIONS: The strongest construct for stabilizing a vertical shear femoral neck fracture is the proximal femoral locking plate, followed in descending order by the dynamic condylar screw, the dynamic hip screw, and the 3 cannulated screw configuration.     

肱骨近端骨折3种不同固定方式重建内侧柱的有限元分析

目的 采用有限元分析肱骨近端骨折锁定钢板联合内侧支撑螺钉、锁定钢板联合腓骨支撑及外侧锁定钢板联合内侧钢板重建内侧柱3种内固定模型的生物力学稳定性.方法 选取1名健康女性志愿者进行肱骨近端CT扫描,按照肱骨解剖颈下5 mm截骨,建立肱骨近端内侧柱缺失型骨折模型,按不同内固定方式分为PC组、PF组、PP组.PCO组单纯应用...