[1]云大科 符丽娜 贾丙申 焦拓 胡帅 纪志华△.重建内侧柱支撑对肱骨近端骨折术后肩关节功能的影响分析[J].中国中医骨伤科杂志,2022,30(03):57-61.
　YUN Dake FU Lina JIA Bingshen JIAO Tuo HU Shuai JI Zhihua.Clinical Study on the Efficacy of Reconstruction of Medial Column Support on Shoulder Joint Function after Proximal Humeral Fracture[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2022,30(03):57-61.
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重建内侧柱支撑对肱骨近端骨折术后肩关节功能的影响分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第30卷
期数:
2022年03期
页码:
57-61
栏目:
临床报道
出版日期:
2022-03-15

文章信息/Info

Title:
Clinical Study on the Efficacy of Reconstruction of Medial Column Support on Shoulder Joint Function after Proximal Humeral Fracture
文章编号:
1005-0205(2022)03-0057-05
作者:
云大科1 符丽娜1 贾丙申1 焦拓1 胡帅1 纪志华1△
1海南医学院第一附属医院关节创伤外科(海口,570102)
Author(s):
YUN Dake1 FU Lina1 JIA Bingshen1 JIAO Tuo1 HU Shuai1 JI Zhihua1△
1Department of Joint Trauma, First Affiliated Hospital of Hainan Medical College, Haikou 570102, China.
关键词:
肱骨近端骨折;  骨折复位内固定;  内侧支撑
Keywords:
proximal humeral fracture;  reduction and internal fixation;  medial support
分类号:
R683.41
文献标志码:
B
摘要:
目的:探讨重建内侧柱支撑治疗肱骨近端骨折的临床疗效。方法:2015年1月至2018年1月因肱骨近端骨折于本科接受锁定钢板治疗且临床资料完整者110例,根据术后X线片明确肱骨近端内侧柱支撑重建情况,分为皮质骨内侧支撑组(A组)57例和无内侧支撑组(B组)53例。于术后1周(H1)、3个月(H2)及术后1年(H3)X线片上测量相对钢板的“肱骨头高度”,并计算在术后1周至术后3个月(ΔH1)、术后3个月至术后1年(ΔH2)期间高度变化情况。在术后3个月及1年时用ASES、Constant-Murley 及Neer评分对肩关节功能进行评定。结果:A组、B组术前一般资料差异无统计学意义(P>0.05)。术后3个月时,A组肱骨头高度H1由(24.7±1.6)mm变为(24.6±1.7)mm,差异无统计学意义(H2,P>0.05),肱骨头高度改变ΔH1为(1.4±0.5)mm; B组肱骨头高度H1由(24.6±1.5)mm变为(21.7±3.3)mm,差异有统计学意义(H2,P<0.05),肱骨头高度改变ΔH1为(3.4±0.5)mm,肱骨头高度变化组间差异有统计学意义(P<0.05)。术后1年时,A组肱骨头高度H2由(24.6±1.7)mm变为(24.7±1.7)mm,差异无统计学意义(P>0.05),肱骨头高度改变ΔH2为(0.5±0.3)mm; B组肱骨头高度H2由(21.7±3.3)mm变为(21.4±3.4)mm,差异有统计学意义(P>0.05),肱骨头高度改变ΔH2为(0.5±0.1)mm,肱骨头高度变化组间差异无统计学意义(P>0.05)。与术后3个月比较,术后1年时A组肩关节术后DASH评分由(31.1±1.5)分降至(16.3±0.8)分,差异有统计学意义(P<0.05); Constant-Murley评分由(61.9±1.9)分增至(87.2±2.0)分,差异有统计学意义(P<0.05); Neer评分由(71.2±1.2)分增至(84.5±1.6)分,差异有统计学意义(P<0.05)。B组DASH评分由(35.7±0.9)分降至(23.0±1.4)分,差异有统计学意义(P<0.05); Constant-Murley评分由(55.0±1.3)分增至(74.5±2.5)分,差异有统计学意义(P<0.05); Neer评分由(62.2±3.8)分增至(70.4±6.3)分,差异有统计学意义(P<0.05)。同一时间点组内及组间评分差异均有统计学意义(P<0.05)。结论:肱骨近端骨折患者手术重建内侧柱支撑,有利于解剖复位,可最大限度避免肩关节功能丢失,提高患者生存质量。
Abstract:
Objective:To explore the clinical efficacy of reconstruction of medial column support on the treatment of proximal humeral fractures.Methods:The clinical data of 110 patients with proximal humerus fractures treated with locking plates from January 2015 to January 2018 were analyzed.According to postoperative X-rays, the reconstruction of the proximal medial column of the humerus was confirmed, which were divided into 57 cases in cortical bone medial support group(group A)and 53 cases in none medial support group(group B).The “humeral head height” relative to the plate was measured on X-rays 1 week(H1), 3 months(H2)and 1 year(H3)after surgery.The height change from 1 week to 3 months after surgery(ΔH1)and from 3 months after the operation to 1 year after the operation(ΔH2)were calculated.The ASES, Constant-Murley and Neer scores were used to assess shoulder joint function at 3 months and 1 year after surgery.Results:There was no statistically significant difference in general data between group A and group B before operation(P>0.05).At 3 months postoperatively, the humeral head height(H1)of group A changed from(24.7±1.6)mm to(24.6±1.7)mm(H2, P>0.05),the humeral head height change(ΔH1)was(1.4±0.5)mm.The head height(H1)of group B changed from(24.6±1.5)mm to(21.7±3.3)mm(H2, P<0.05), the humeral head height change(ΔH1)was(3.4±0.5)mm, and the difference between the humeral head height changes was statistically significant(P<0.05).One year after the operation, the humeral head height(H2)of group A changed from(24.6±1.7)mm to(24.7±1.7)mm(P>0.05),the humeral head height change(ΔH2)was(0.5±0.3)mm, the humeral head height(H2)of group B from(21.7±3.3)mm to(21.4±3.4)mm(P>0.05),the humeral head height change(ΔH2)was(0.5±0.1)mm,there was no significant difference between the groups in the humeral head height change(P>0.05).Compared with 3 months after operation, the postoperative DASH score of shoulder joint in group A decreased from 31.1±1.5 to 16.3±0.8(P<0.05)at 1 year after operation, and the Constant-Murley score increased from 61.9±1.9 to 87.2±2.0(P<0.05).Neer score increased from 71.2±1.2 to 84.5±1.6(P<0.05); Group B DASH score decreased from 35.7±0.9 to 23.0±1.4(P<0.05).Constant-Murley score increased from 55.0±1.3 increased to 74.5±2.5(P<0.05); Neer score increased from 62.2±3.8 to 70.4±6.3(P<0.05).The differences in scores within and between groups at the same time point were statistically significant(P<0.05).Conclusion:The surgical reconstruction of the medial column support for patients with proximal humeral fractures is beneficial to anatomical reduction, which can minimize the loss of shoulder joint function and improve the quality of life of patients.

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更新日期/Last Update: 1900-01-01