[1]徐华中 杨玉生△ 施克勤.经皮微创三切口逆行插入钢板内固定治疗肱骨近端骨折36例[J].中国中医骨伤科杂志,2019,27(12):79-83.
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经皮微创三切口逆行插入钢板内固定治疗肱骨近端骨折36例()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第27卷
期数:
2019年12期
页码:
79-83
栏目:
临床报道
出版日期:
2019-12-04

文章信息/Info

文章编号:
1005-0205(2019)12-0079-05
作者:
徐华中1 杨玉生1△ 施克勤1
1南京医科大学附属无锡第二人民医院骨科(江苏 无锡,214002)
关键词:
肱骨近端骨折 内固定 经皮 微创
分类号:
R683.41
文献标志码:
B
摘要:
目的:探讨经骨折远端经皮逆行插入锁定钢板治疗简单类型肱骨近端骨折的手术方法及疗效。方法:2016年1月至2018年12月应用经骨折远端经皮逆行插入锁定钢板治疗简单类型肱骨近端骨折36例,均采用经皮微创逆行插入锁定钢板内固定技术固定,其中Neer Ⅱ型(两部分骨折)11例,Neer Ⅲ型(三部分骨折)25例; 随访9~18个月,观察肩关节功能评分、骨折愈合及并发症发生情况。结果:所有患者均获得随访,随访时间9~18个月,平均13.6个月; 所有骨折均达到骨性愈合,愈合时间10~15周,平均骨折愈合时间10.5周。所有骨折均满意复位,手术时间50~120 min,平均81 min; 无一例腋神经损伤发生; 术后肩关节Neers功能评分,优28例(90~100分),良5例(80~90分),可3例(70~79分),优良率91.7%.无神经、血管损伤及感染等并发症发生。结论:基于C臂机精准定位,通过肱骨近端骨折附近的间断三切口,可实现内植物钢板和螺钉在肱骨近端骨折部位的经皮精准放置; 可有效缩短手术时间,减少软组织损伤,改善术后肩关节功能,促进骨折愈合与预防腋神经损伤及感染等并发症的发生。

参考文献/References:

[1] THEOPOLD J,WEIHS K,MARQUA B,et al.Detection of primary screw perforation in locking plate osteosynthesis of proximal humerus fracture by intra-operative 3D fluoroscopy[J].Arch Orthop Trauma Surg,2017,137(11):1491-1498. [2] NEER CS 2ND.Displaced proximal humeral fractures:part 1:classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089. [3] 尚天裕.中国接骨学[M].天津:天津科学技术出版社,1995:82. [4] DAI J,CHAI Y,WANG C,et al.Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures[J].European Journal of Orthopaedic Surgery & Traumatology,2014,24(3):305-313. [5] 周健生,吴征杰,陈小康,等.锁定钢板治疗肱骨近端骨折112例[J].中国中医骨伤科杂志,2018,26(4):64-66. [6] 陈苑妮,黎清斌,张兆华,等.手法复位小夹板外固定治疗老年Neer Ⅲ型肱骨近端骨折36例[J].中国中医骨伤科杂志,2017,25(6):23-26. [7] ZHAO W,ZHANG Y,JOHANSSON D,et al.Comparison of minimally invasive percutaneous plate osteosynthesis and open reduction internal fixation on proximal humeral fracture in elder patients:a systematic review and meta-analysis[J].BioMed Research International,2017:3431609. [8] SOHN H S,JEON Y S,Lee J,et al.Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures:A prospective randomized controlled trial[J].Injury,2017,48(6):1175-1182. [9] BOILEAU P,WALCH G.The three-dimensional geometry of the proximal humerus.Implications for surgical technique and prosthetic design[J].Journal of Bone & Joint Surgery:British Volume,1997,79(5):857-865. [10] BULCHLER P,FARRON A.Benefits of anatomical reconstruction of the humeralhead during shoulder arthroplasty:a finite element analysis[J].Clin Biomech,2004,19(1):16-23.[11] DINES D M,WARREN R F.Modular shoulder hemiarthroplasty for acute fractures:surgical considerations[J].Clinical Orthopaedics & Related Research,1994,307:18-26. [12] DIMAKOPOULOS P,POTAMITIS N,LAMBIRIS E.Hemiarthroplasty in the treatment of comminuted intraarticular fractures of the proximal humerus[J].Clinical Orthopaedics and Related Research,1997,341:7-11. [13] 张英泽.骨科手术路径[M].北京:人民卫生出版社,2011:32-39. [14] 马秀才,傅德皓,林松,等.微创经皮钢板接骨术治疗肱骨近端骨折[ J].实用骨科杂志,2014,20(1):102-105. [15] 赵吉鹏,胡万坤,张秋林,等.有限切开三角肌入路肱骨近端锁定接骨板治疗肱骨近端骨折[J].中国骨伤,2012,25(2):155-157. [16] GARDNER M J,WEIL Y,BARKER J U,et al.The impoflanee of medial support in locked plating of proximal humerus fraetures[J].J Orthop Trauma,2007,21(3):185-191. [17] KRAPPINGER D,BIZZOTTO N,RIEDMANN S,et al.Predicting failure after surgical fixation of proximal humerus fractures[J].Injury,2011,42(11):1283-1288. [18] HE Y,ZHANG Y,WANG Y,et al.Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support[J].Journal of Orthopaedic Surgery & Research,2017,12(1):72-77. [19] SHEN Q F,WEN X,YANG S W,et al.MIPPO and ORIF for the treatment of elderly proximal humerus fractures of type Neer Ⅱ:a case control study[J].China Journal of Orthopaedics & Traumatology,2018,31(2):160-164. [20] EGOL K A,SUGI M T,ONG C C,et al.Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures[J].J Shoulder Elbow Surg,2012,21(6):741-748. [21] LESCHEID J,ZDERO R,SHAH S,et al.The biomechanics of locked plating for repairing proximal humerus fractures with or without medial conical support[J].J Trauma,2010,69(5):1235-1242. [22] SCHUHE L M,MATTEINI L E,NEVIASERIL L.Proximal periartieular locking plates in proximal humeral fractures:functional outcomes[J].J Shoulder Elbow Surg,2011,20(8):1234-1240. [23] YUAN F,HAN Y,PAN Z,et al.Proximal humeral fracture treated with proximal humeral internal locking system(PHILOS)via a T-shaped small incision[J].Journal of Medical Imaging & Health Informatics,2018,8(2):374-377. [24] MARTINEZHUEDO M A,JIMÉNEZGARCÍA R,MORAZAMORANO E,et al.Trends in incidence of proximal humerus fractures,surgical procedures and outcomes among elderly hospitalized patients with and without type 2 diabetes in Spain(2001—2013)[J].Bmc Musculoskeletal Disorders,2017,18(1):522-528. [25] NERZ C,SCHWICKERT L,BECKER C,et al.Effectiveness of robot-assisted training added to conventional rehabilitation in patients with humeral fracture early after surgical treatment:protocol of a randomised,controlled,multicentre trial[J].Trials,2017,18(1):589-595.

备注/Memo

备注/Memo:
通信作者 E-mail:wxeyyys@163.com(收稿日期:2019-07-01)
更新日期/Last Update: 2019-12-04