经皮穿针固定治疗肱骨近端骨折

目的　对应用经皮穿针固定治疗肱骨近端骨折的疗效、适应证和手术方法进行总结分析。方法　随访 4 9例应用经皮穿针固定治疗的肱骨近端新鲜闭合骨折患者 ,平均随访时间 16 9个月。患者平均年龄 4 0 4岁。 2部分外科颈骨折 39例 ,2部分大结节骨折 6例 ,外展嵌插 4部分骨折 4例。最终随访时进行ASES评分、Constant Murley评分、UCLA评分以及SST(SimpleShoulderTest)问卷评估。结果　 4 9例患者ASES评分平均为 91 4 ,VAS疼痛评分平均为 1 7,肩关节活动度平均为前屈上举 14 6 7°,外旋 39 6°,内旋T8～T9水平 ;Constant Murley评分平均为 88 2 ;UCLA评分平均为 31 2 ;SST问卷中回答“是”的问题平均为 10 1个。 4 9例患者骨折均愈合 ,平均愈合时间为 8 8周。患者对于疼痛的满意度为 95 9% (4 7/ 4 9) ,对于功能恢复的满意度为 91 8% (4 5 / 4 9)。最终随访时均未出现肱骨头坏死的征象。结论　应用经皮穿针固定治疗大多数 2部分外科颈骨折、外展嵌插型的 2部分大结节骨折以及外展嵌插 4部分骨折可得到良好的治疗效果 ;结合及时、充分的术后康复 ,经皮穿针固定是治疗特定类型肱骨近端骨折的一种有效的方法     

经皮穿针治疗儿童肱骨近端骨折

自1997年2月～2001年4月,作者采用手法整复、经皮穿针治疗儿童不稳定型肱骨近端骨折38例,效果良好,现总结报告如下.     

肱骨近端骨折经皮穿针固定的生物力学研究

目的 通过生物力学实验研究探讨应用经皮穿针固定治疗肱骨近端骨折时固定针构型对骨折稳定性的影响,探讨临床工作中如何进一步改善骨折固定的生物力学稳定性。方法将18对36根新鲜冷冻成人肱骨干标本配对分为4小组,实验前对所有肱骨干标本进行双能骨密度检查以排除骨质情况对实验结果的影响。按统一标准制作肱骨近端2部分外科颈骨折模型,之后使用4根直径2．5mm螺纹针对2个小组进行统一方式的平行构型固定,对另外2小组进行统一方式的扇形交汇构型固定。应用Instron5566生物力学试验机对尸体标本进行生物力学测定,对比两种构型的抗剪切应力强度与抗扭转应力强度。结果 在抗剪切应力方面两种固定构型没有明显的区别(P=0．73),而在抗扭转应力方面平行构型固定则明显优于扇形交汇构型固定(P=0．04)。结论 通过生物力学实验的结果,我们认为在条件允许的情况下尽可能使用平行构型的方式穿针固定,若无法进行平行的固定或不能保证平行固定针之间的距离在1cm以上时,则仍应采用扇形交汇构型的固定方式进行固定。     

经皮穿针固定治疗肱骨近端骨折

肱骨近端骨折是一种临床常见的骨折类型,占全身骨折的2％～4％,其中15％为不稳定骨折,肱骨近端骨折可发生于任何年龄,常见于老年患者,和骨质疏松有关;在青少年中,由于活动能力增加,骺板相对薄弱,发生率有所增加,多为Salter—HarrisⅡ型骺损伤。对于存在移位或移位倾向的肱骨近端不稳定性骨折,应手术治疗。现将我院自2003年2月至2006年1月对33例得到随访的肱骨近端骨折经皮穿针固定手术治疗的结果分析研究如下。     

手法整复经皮穿针固定治疗肱骨近端骨折

作者1998年1月～2004年10月采用手法整复经皮穿针固定治疗肱骨近端骨折64例，取得满意疗效。     

经皮穿针固定治疗儿童肱骨髁上骨折

目的探讨经皮穿针固定治疗儿童肱骨踝上骨折的临床疗效。方法复位后,在荧光屏或C型臂下,患肢于屈肘、前臂旋前、肩外展外旋位,避开尺神经,分别在内上髁及外上髁进针,针的粗细为1.5~2 mm,穿过近折断的皮质即可,两针交叉,针尾剪短,折弯90°留于皮外。石膏托固定2周后开始功能练习,治疗过程中按中医辩证内服中药。结果本组48例随访5个月至5年,骨折全部愈合,平均4.5周。根据综合评定,优95.8%,良4.2%。结论本方法简易,取材方便,价格低廉,适用基层。配合内服中药,消退肿胀,有效止痛,肘关节能早期活动,有利于功能恢复。     

经皮穿针内固定治疗肱骨髁上骨折

自 1994～ 1996年我院采用手法复位、经皮内外髁交叉克氏针内固定治疗肱骨髁上骨折 6 5例 ,治疗效果满意。报告如下 :1　临床资料　　本组共 6 5例 ,男 43例 ,女 2 2例 ;年龄 3～ 13岁 ;右侧 36例 ,左侧 2 9例 ;伸直型 6 2例 ,屈曲型 3例。病程最短 2小时 ,最长 4天。全部是闭合性骨折。合并尺神经挫伤 3例。2　治疗方法臂丛麻醉 ,常规消毒 ,铺无菌巾。在电视透视下手法复位 ,复位成功后 ,屈肘 90°～ 12 0° ,用直径 1 5～ 2 0ｍｍ克氏针从内外髁交叉钻入 ,进针方向与肱骨纵轴 45°～ 6 0° ,斜向对侧骨皮质。内髁要触摸定位准确 ,力求从…     

经皮逆行穿针固定掌骨干骨折38例

我院自1998年以来,采用经皮逆行髓内穿针固定治疗掌骨干不稳定骨折38例,疗效满意,现报告如下.     

应用肱骨近端锁定型髓内针治疗肱骨近端骨折的临床疗效分析

目的探讨应用肱骨近端髓内针治疗肱骨近端两部分外科颈骨折的疗效。方法回顾性分析22例应用锁定型肱骨近端髓内针治疗两部分外科颈新鲜骨折患者的临床资料,患者平均年龄57岁。最终随访时拍摄肩关节X线片以评价愈合情况,并应用可视模拟评分法（VAS）评分,美国肩肘外科医师评分（ASES）,Constant-Murley评分,UCLA评分以及简易肩关节测验（SST）问卷评估。结果所有患者均获随访,平均随访时间为13个月,22例患者骨折均在术后8周内初步愈合。随访过程中未出现感染、肱骨头坏死以及任何与内固定物有关的并发症。术后患肢主动前屈上举平均为147．8°,主动体侧外旋平均为45．5°,主动内旋平均达T10水平。术后患者疼痛VAS评分平均为1．5。平均ASES评分为81．2,Constant-Murley评分为85．4,UCLA评分为29．9,SST评分为9．5。18例患者的肩关节功能评估为优或良,4例患者肩关节功能评估为差。结论闭合复位、锁定型肱骨近端髓内针固定术是治疗肱骨近端两部分外科颈骨折的一种有效的手术方式。     

闭合复位经皮穿针治疗肱骨近端移位骨折

目的探讨闭合复位经皮穿针固定治疗肱骨近端移位骨折的临床疗效。方法2004年6月～2006年6月,采用闭合复位、经皮穿针治疗15例肱骨近端移位新鲜骨折。结果15例随访12～24个月,平均15.8月,肩关节功能评分采用Neer评分法,优9例,良4例,可2例,优良率86.7%（13/15）。所有骨折在术后8～12周愈合,无固定失效,未出现肱骨头坏死。术中1例断针,术后1例针游移穿出,1例腋神经部分损伤。结论闭合复位经皮穿针固定治疗肱骨近端移位新鲜骨折手术固定可靠,术后可早期功能锻炼,疗效满意。     

Treatment of severely displaced proximal humeral fractures in children with retrograde elastic stable intramedullary nailing

We report our experience of elastic stable intramedullary nailing (ESIN) of severely displaced proximal humeral fracture Type III and IV according to Neer in children. Thirty-five children (mean age 12.7 years) with 19 Salter–Harris Type II epiphyseal fractures and 16 children with metaphyseal fractures of the proximal humerus were treated with ESIN by one-nail or two-nail-technique. There were the following complications: two perforations of the nail at the head of the humerus with loss of position, one loss of position without nail perforation, one misplacement of a nail, one revision due to haematoma and two difficult removals of metal. For follow-up examinations after 26 months the children were classified by use of the Constant–Murley score. On average they gained 99 points. All children were able to resume their sporting activities as before. For the treatment of displaced proximal humeral fractures in children more than 10 years old the retrograde ESIN represents a safe minimal invasive surgical procedure.     

Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment

Introduction A variety of different treatment options are available for displaced three- or four-part fractures. In a retrospective cohort study we evaluated the results of intramedullary nailing with the ACE nail and conservative treatment of displaced proximal humeral fractures. Materials and methods Twenty-four patients suffered a neer 4, 5 or 6 proximal humeral fracture who were treated with intramedullary nailing. Sixteen patients received conservative treatment for their Neer 4, 5 or 6 fracture. Results Taking critical remarks in consideration, the results of intramedullary nailing are not very satisfactory compared to the conservative-treated group. However functional results of our operative group are comparable to those from other studies in literature. Conclusion Displaced three- or four-part proximal humeral fractures can be treated by intramedullary nailing. Familiarity with the fracture deformity and experience with the surgical techniques are critical for successful operative treatment outcome. Most complications in the operative treatment group can be avoided; inadequate reduction can lead to wrong insertion place with secondary problems (dislocation and subacromial impingement). Also future improvements in osteosynthesis like angle stable screw fixation (osteoporosis) and minimally invasive device will probably decrease the complication rate.     

自锁髓内钉固定治疗肱骨干骨折

年1月～2004年5月,我们采用自锁髓内钉内固定治疗肱骨干骨折,同时行桡神经探查术,效果满意,报道如下.     

逆行性可膨胀髓内钉治疗股骨干骨折

目的探讨逆行性可膨胀髓内钉在股骨干中段及中下段骨折治疗中的临床疗效。方法对9例股骨干中段及中下段骨折患者采用逆行性可膨胀髓内钉进行内固定。结果 9例均获随访,时间10～18个月。骨折均愈合,时间2～6个月。膝关节功能按Lysholm评分为74～94分,优6例,良2例,可1例。结论逆行性可膨胀髓内钉治疗股骨中段及中下段骨折创伤小,关节功能恢复较快。     

带锁髓内钉治疗肱骨骨折

2002年9月～2005年12月,我科应用带锁髓内钉治疗肱骨干骨折16例。效果满意。     

肱骨交锁髓内钉治疗肱骨骨折术后骨不连

目的介绍应用肱骨交锁髓内钉治疗肱骨骨折术后骨不连的经验。方法1997年10月～2001年7月,应用肱骨交锁髓内钉治疗12例肱骨骨折术后骨不连患者,其中肥大型5例,萎缩型2例,假关节形成5例。受伤至骨不连手术的时间平均为10．5个月(5～33个月)。手术采用开放复位顺行置入髓内钉,锁入远端交锁钉后向近端打拔以使断端加压,自体髂骨及RBX植骨。结果所有患者获平均21个月(9～51个月)随访。12例患者骨不连均获得愈合,平均愈合时间为5．8个月(3．5～8．0个月)。其中1例去除髓内钉后1年于原骨不连部位发生再骨折,重新植骨内固定而获得愈合。11例肩关节及上肢功能恢复良好。所有患者未遗留神经损伤症状。结论肱骨交锁髓内钉为治疗肱骨骨折术后骨不连的有效方法。     

Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children

Purpose To demonstrate the effectiveness of intramedullary fixation of severely displaced proximal humeral physeal fractures in skeletally immature children using the elastic stable intramedullary nail (ESIN). Methods Retrospective recruitment of 14 patients aged 10–15-years old with severely displaced proximal humeral physeal fractures between 1999 and 2004 in a single regional specialist paediatric orthopaedic hospital. The fractures were graded using the Neer classification; severe displacement constituted Neer II–IV or displacement >1 cm and angulation >45°. Patients were followed up and assessed using the Disabilities of the Arm, Shoulder and Hand score (DASH) and the Neer Shoulder score. Radiographs were assessed for deformity. Subjective satisfaction was assessed. Results Fourteen patients with mean follow-up of 30 months (12–66 m) from surgery. All fractures were radiologically united at a median time of eight weeks (7–10 weeks). At follow-up, Neer Shoulder mean score was 96.79 (range 83–100) and DASH mean score 2.26 (0–7.5). Subjectively 71% were very satisfied and 29% were satisfied. Conclusions We commend stabilisation using ESIN in the management of the displaced proximal humeral physeal fracture in older children, once reduction of the fracture has been achieved by either closed or open means. ESIN is safe and allows early return to pre-injury function.     

钢板内固定和髓内钉固定治疗肱骨干骨折的系统评价

[目的]对钢板内固定与髓内钉固定治疗成人肱骨干骨折的疗效进行系统评价.[方法]在Pubmed、Co-chrane Library、EMBASE、Science Direct以及CNKI、CBM、中国医学学术会议论文数据库等网站进行检索.文献检索起止时间为1995年1月～2010年9月.再对入选文献的参考文献进行手工检索.系统收集钢板内固定和髓内钉固定治疗肱骨干骨折的相关文献,并按临床科研方法的国际通用原则进行阅读和评价.采用Cochrane协作网提供的软件Revman 4.2进行Meta-分析,以获得钢板内固定和髓内钉固定治疗肱骨干骨折的疗效及其安全性指标的相关证据.[结果]共检索到192篇原始文献,有6篇符合最终的入选标准,总计随访患者335例.Meta分析结果表明,钢板内固定与髓内钉固定比较,可显著降低再次手术发生率但是增加术后感染率.[结论]钢板内固定可显著降低再次手术发生率但是增加术后感染率.在骨折不愈合率、医源性神经损伤等方面,两者差异无统计学意义.因本次系统评价纳入病例数较少,尚需要更多设计严谨的大样本随机对照研究来增加证据的论证强度.     

逆行交锁髓内钉治疗肱骨骨折

我科2001年1月-2002年12月采用带锁髓内钉逆行穿钉的方法治疗肱骨干骨折23例，疗效满意。     

Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures

INTRODUCTION: The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial. Different treatment modalities are available. Mechanical implant-related problems, however, and the preservation of the biological integrity of the humeral head remain unsolved. New implants providing angular stability are expected to maintain the intraoperative result of reduction until definitive healing. The purpose of this study was to evaluate the functional outcome and the complication rate of an angular and sliding stable antegrade interlocking nail for the treatment of displaced proximal humeral fractures. MATERIALS AND METHODS: In a prospective study, 112 consecutive patients with displaced proximal humeral fractures were treated. Complete 12 months postoperative follow-up was available for 74 patients. Fracture types were classified according to the Neer-classification. Clinical, functional and radiographic follow-up evaluations were performed 3, 6 and 12 months after surgery. The Constant Score (CS) was used to assess shoulder function. RESULTS: All fractures were united. The CS (MV +/- SD) of the injured side 3, 6 and 12 months after surgery were 42.1 +/- 15.1, 56.1 +/- 20.1 and 70.9 +/- 19.3, respectively. Patients sustaining Neer III and VI/3 fractures revealed better shoulder function (68.8 +/- 14.7, 74.9 +/- 17.6) 12 months postoperatively than those with Neer IV/4 fractures (60.7 +/- 23.2), where most complications occurred. Complications requiring surgical therapy were seen in a total of 24 patients (30%) and included backing out of screws in nails without peak inlay (20%; 2000-2003), protrusion of screws into the gleno-humeral joint (5%), loss of reduction with malunion (9%) and major tubercle displacement (7%). CONCLUSION: The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail (Targon-PH) led to good functional results, especially in 2- and 3-part fractures. There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures. Lateral backing out of screws was abolished by implant modifications (PEEK-inlay) from 2003 onwards. Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement.