摘要
目的 探讨改良肩峰前下双切口钢板内固定治疗外展嵌插型三、四部分肱骨近端骨折的临床疗效.方法 回顾性分析福州市第二总医院于2018年11月至2021年11月期间采用改良肩峰前下双切口钢板内固定治疗的35例外展嵌插型三、四部分肱骨近端骨折患者的病历资料,男15例、女20例,年龄(61.7±7.8)岁(范围40～73岁).根据Neer分型,三部分骨折17例、四部分骨折18例.采用改良肩峰前下双切口入路,自三角肌前束自然间隙进入,对骨折端进行复位及钢板内固定.统计手术时间、切口长度、X线透视时间、随访时间和肩关节Constant-Murley评分、骨折愈合时间、疼痛视觉模拟评分(visual analogue scale,VAS)及肱骨颈干角等.记录术中及术后并发症的发生情况.结果 35例患者均顺利完成手术,切口长度为(8.1±0.3)cm(范围7.6～9.0 cm),手术时间为(87.3±9.3)min(范围70～110 min).术中X线透视时间为(6.6±0.3)s,Neer分型三部分骨折为(6.3±0.2)s、四部分骨折为(6.8±0.2)s,差异有统计学意义(t=6.350,P＜0.001).随访时间为(22.1±5.8)个月(范围14～31个月).骨折愈合时间为(11.8±1.4)周(范围10～15周).末次随访时VAS评分为(1.6± 0.7)分(范围1～3分);肩关节Constant-Murley评分为(89.6±2.9)分(范围84～95分);肱骨颈干角为133.4°±3.1°(范围128°～138°),Neer分型三部分骨折为133.6°±3.5°、四部分骨折为133.3°±2.8°,差异无统计学意义(t=0.288,P=0.075).未观察到肱骨头坏死、骨折部位内翻塌陷、腋神经损伤等并发症.结论 改良肩峰前下双切口钢板内固定治疗外展嵌插型三、四部分肱骨近端骨折具有创伤小、安全有效的特点,可获得良好的早期疗效.
Abstract
Objective To evaluate the clinical efficacy of modified anterior subacromial approach plate internal fixation for three-or four-part valgus impacted proximal humeral fractures.Methods A retrospective analysis of 35 patients treated be-tween November 2018 and November 2021 at Fuzhou Second General Hospital was performed,including 15 males and 20 females aged 61.7±7.8 years(range:40 to 73 years).Patients were classified under the Neer system;17 had 3-part fractures and 18 had 4-part fractures.The modified approach accessed the fracture site via the natural interval of the deltoid anterior bundle,facilitating fracture reduction and fixation using a plate.Operative time,incision length,intraoperative fluoroscopy time,follow-up duration,Constant-Murley score,fracture healing time,visual analogue scale(VAS)for pain,and humeral neck-shaft angle were assessed.Intraoperative and postoperative complications were also recorded.Results All patients underwent successful surgery,with an average incision length of 8.1±0.3 cm(range,7.6-9.0 cm)and intraoperative fluoroscopy time of 6.6±0.3 seconds(3-part fractures:6.3±0.2 s,4-part fractures:6.8±0.2 s,t=6.350,P＜0.001).Follow-up averaged 22.1±5.8 months(range,14-31 months).Fracture healing occurred in 11.8±1.4 weeks(range,10-15 weeks).At the final assessment,the VAS score was 1.6±0.7(range,1-3),the Constant-Murley score was 89.6±2.9(range,84-95),and the humeral neck-shaft angle was 133.4°±3.1°(range,128°-138°;3-part fractures:133.6°±3.5°,4-part fractures:133.3°±2.8°,t=0.288,P=0.075).No complications such as avascular necrosis of the hu-meral head,varus collapse of the fracture site,or axillary nerve injury were recorded.Conclusion The modified anterior subacro-mial approach plate internal fixation is a minimally invasive,safe,and effective treatment for valgus impacted three-and four-part proximal humeral fractures,demonstrated by excellent surgical outcomes and absence of major complications.
基金项目
福州市科技计划项目(2021-S-161)
福建省创伤骨科急救与康复临床医学研究中心(2020Y2014)
福州市卫生健康科技创新平台建设项目(2019-S-wp2)
NETL
NSTL
万方数据