锁定钢板治疗肱骨近端骨折的疗效

目的 探讨肱骨近端锁定钢板治疗肱骨近端骨折的临床疗效。 方法 回顾性分析2013年12月-2016年6月滁州市第一人民医院骨科收治的32例肱骨近端骨折,采用神经阻滞麻醉或全身麻醉,均利用胸大肌三角肌间隙入路,松解三角肌前方部分止点,暴露骨折端,识别大、小结节及肱二头肌长头腱,用缝线缝扎于大小结节的腱骨联合处作为牵引线,骨折复位满意后,安置肱骨近端锁定钢板,术后根据骨折类型及骨质固定情况个性化指导肩关节功能锻炼,以患者术后疼痛、功能、运动范围、解剖位置为综合的肩关节Neer评分法评估其肩关节术后恢复效果。 结果 骨折术后复查X线片示:31例骨折复位满意,1例复位欠佳;所有患者均获得随访,随访时间10~16个月。32例患者4~8个月后均达到骨性愈合,患者无肩峰撞击,无复位丢失,无肱骨头坏死,无切口感染,无螺钉松动及穿出肱骨头;以患者术后疼痛(35分)、功能(30分)、运动范围(25分)、解剖位置(10分)为综合的肩关节Neer评分法评估其肩关节功能:本组患者优28例,良2例,可2例。 结论 肱骨近端锁定钢板经胸大肌三角肌间隙入路治疗肱骨近端骨折具有固定牢固,术后功能好,并发症少等优点。 

Clinical effects of locking plate fixation of proximal humerus fracture

Objective To explore the clinical effect of locking plate fixation of the proximal humeral fractures. Methods Total 32 cases of proximal humerus fracture treated with locking plate in orthopedics department of the First People's Hospital of Chuzhou from December, 2013 to June, 2016. The block anesthesia or general anesthesia was carried out during the operation. Via intermuscular space between pectoralis major and deltoid muscle, deltoid muscle partial insertions were loosen, and the end of the fracture was exposed, the large and small nodules and long head tendons of the biceps brachii were identified. The suture stitched in the joint of the tendon and bone of the size nodules was used as a traction line. After the fracture reduction is satisfactory, the proximal locking plate of the humerus was placed. After the operation, the function of the shoulder joint function was individualized according to the type of fracture and the fixation of the bone. Function, motion range and anatomical position were evaluated by Neer scoring system. Results The X-ray film was reviewed after the operation:31 patients were satisfied with fracture reduction, and one case was not well restored. All 32 patients were followed up for 10 to 16 months. The fracture healing time was 4-8 months. All 32 patients had bone healing, 31 patients were satisfactory reduction and one patient had poor reposition. There was no shoulder peak impact, no reset loss, no humeral head necrosis, no incision infection, no screw loose and wear the humeral head. The function of shoulder joint was evaluated by the Neer scoring method which postoperative pain (35 points), function (30 points), motion range (25 points), and anatomical position (10 points). Twenty-eight cases got excellent result, 2 cases good and 2 case poor. Conclusion The locking plate inserted into the path through the pectoralis major deltoid muscle for proximal humerus fractures has the advantages of fixed firmness, good postoperative function and few complications.