|其他题名||Locking plates and semi-shoulder arthroplasty for complex proximal humeral fractures
|吕扬; 李少柟; 周方; 田耘; 姬洪全; 张志山
|摘要||目的 探讨锁定钛板及半肩关节置换术治疗肱骨近端骨折的疗效与适应证。方法 2005年1月至2008年12月共收治51例肱骨近端骨折患者，其中39例获得随方，男12例，女27例；平均年龄65.1岁（17 ～ 80岁）。骨折按Neer分型：二部分骨折23例，三部分骨折10例，四部分骨折6例。受伤至手术时间平均为5.5d(1～9d)。手术方式选择：二部分骨折及年龄＜60岁的患者使用锁定钛板内固定治疗，四部分骨折及年龄＞ 60岁的患者使用半肩关节置换术。本组使用肱骨近端内固定系统(PHILOS)钛板切开复位内固定32例（PHILOS钛板组），其中二部分骨折23例,三部分骨折9例；采用肱骨头置换术治疗7例（关节置换组），其中三部分骨折1例，四部分骨折6例。结果 PHILOS钛板组患者手术时间平均为84 min(60 ～ 140 min),失血量平均为155 mL( 100 ～400 mL)；关节置换组患者手术时间平均为125 min( 100 ～ 170 min)，失血量平均为220 mL(150～450) mL。39例患者术后获平均23个月（16～46个月）随访，无一例出现并发症。PHILOS钛板组28例术后3个月复查X线片示骨折愈合，另4例术后6个月骨折愈合，肩臂手功能丧失量表(DASH)评分平均为20.7分，患者对手术主观满意率为87.5％。关节置换组7例患者DASH评分平均为36.0分，患者对手术主观满意率为71.4％。结论 对于年龄＜60岁的患者及大部分Neer 二、三部分骨折的老年患者，可以选择PHILOS钛板内固定治疗，而年龄＞60岁的四部分骨折患者选择半肩关节置换术可以获得较满意的疗效。
ObjectiveTo explore the clinical effects and indications of locking plates and semi-shoulder arthroplasty for complex proximal humeral fractures. Methods Thirty-nine cases of proximal humeral fractures were treated from January 2005 to December 2008. They were 12 men and 27 women, with a mean age of 65.1 years. According to Neer classification, there were 23 cases of two-part fracture, 10 cases of three-part fracture, and 6 cases of four-part fracture. Patients with two-part fracture and an age of ＜ 60 years were treated with open reduction and internal fixation (ORIF) with proximal humeral intemal locking system(PHILOS) . Patients with three-part fracture were treated with ORIF and arthroplasty. Patients with four-part fracture and an age of ＞ 60 years were treated with arthroplasty. Altogether, ORIF was performed in 32 cases (23 in two-part fractures and 9 in three-part fractures). Arthroplasty was performed in 7 cases (one in three-part fracture and 6 in four-part fractures).Results In the ORIF group, the average surgical time was 84 minutes (from 60 to 140 minutes) and the average blood loss was 155 mL (from 100 to 400 mL). In the arthroplasty group, the average surgical time was 125 minutes (from 100 to 170 minutes) and the average blood loss was 220 mL (from 150 to 450 mL). The average follow-up was 23 months (from 16 to46 months)for the 39 cases. No complications were found. X-ray showed 28 fractures were healed in 3 months and 4 were healed in 6 months after operation. The Disabilities of the Arm, Shoulder and tand(DASH) scores averaged 20.7 points for the ORIF group (from 10 to 42 points) and 36. 0 points for the arthroplasty group (from 18 to 52 points).ConclusionIn treatment of proximal humeral fractures, patients with two-part fracture and aged ＜ 60 years can be managed by ORIF, patients with three-part fracture can be managed by ORIF and semi-shoulder arthroplasty, and patients with four-part fracture and aged ＞ 60 years can be managed by semi-shoulder arthroplasty.|
吕扬,李少柟,周方,等. 锁定钛板及半肩关节置换治疗肱骨近端骨折的疗效分析[J]. 中华创伤骨科杂志,2011,13(3):226-229.
吕扬,et al."锁定钛板及半肩关节置换治疗肱骨近端骨折的疗效分析".中华创伤骨科杂志 13.3(2011):226-229.
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