不同内侧柱支撑锁定钢板固定治疗肱骨近端骨折临床研究.docVIP

不同内侧柱支撑锁定钢板固定治疗肱骨近端骨折的临床研究 　　[摘要] 目的 探讨不同内侧柱支撑锁定钢板固定治疗肱骨近端骨折对治疗效果、功能恢复、并发症及二次手术的影响。 方法 选择143例肱骨近端骨折患者，依据内侧柱支撑方式分为A组（肱骨近端内侧骨皮质支撑62例）、B组（肱骨头下方内侧柱支撑螺钉支撑45例）和C组（无内侧柱支撑36例）。 结果 三组Neer评分、VAS评分、骨折愈合时间、肱骨头内翻角、肱骨头高度丢失差异有统计学意义（P0.05），A组骨折愈合时间最短（P0.05），但A组并发症总发生率及二次手术率最低，C组最高，差异有统计学意义（P0.05）。 结论 肱骨近端内侧骨皮质支撑固定效果、愈合效果、功能恢复效果均较佳，肱骨头下方内侧柱支撑螺钉支撑也有较好效果，在肱骨近端无法进行骨皮质支撑时可作为较理想的选择。 　　[关键词] 肱骨近端骨折；内侧柱支撑；锁定钢板固定；内固定 　　[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2015）08-0071-04 　　[Abstract] Objective To investigate the impact on treatment effect and functional recovery， complications and the second surgery of the different medial column support locking for proximal humerus fractures. Methods A total of 143 cases of proximal humerus fractures， accorded to the medial column support were divided into medial cortical bone of the proximal humerus support in group A （62 cases）， support screw support of humeral head beneath the medial column in group B （45 cases）， no inside column support in group C （36 cases）. Results The differences of Neer score， VAS score， fracture healing time， turned the corner in the humeral head， humeral head height loss among three groups were statistically significant（P0.05）， A group healing shortest （P0.05）， but the overall incidence of complications and rate of reoperation in group A were lowest， that in group C was the highest， the difference was statistically significant （P0.05）. Conclusion The medial cortex of the proximal humerus bone supporting fixed effects， healing effect， when functional recovery has better results， medial column support screws underneath the humeral head support and has a good effect on cortical bone of the proximal humerus could not be supported and fixed adoption. 　　[Key words] Proximal humerus fractures；Medial column support；Locking plate fixation；Internal fixation 　　肱骨近端骨折累及肩关节对患者上肢运动造成严重影响，切开复位锁定钢板内固定是主要的固定方式，但固定不佳可能引起关节面损伤、移位、内翻、肩袖损伤、肩峰撞击综合征等并发症造成患者肩关节功能预后不良，甚至需要二次手术进行翻修[1]。虽然技术及材料发展提高了内固定的稳定性和成功率，但仍有约近20%的固定失败率[2]。临床研究认为骨质疏松、粉碎程度高