锁定钢板内固定治疗肱骨近端骨折的临床应用价值(1)
[摘要]目的探讨青壮年高能量创伤和老年人骨疏松性肱骨近端严重移位复杂骨折的新方法,方法 对我院2008年元月至2010年元月,采用锁定钢板内固定治疗肱骨近端骨折32例,术前均行计算机X线摄影(DR)片检查,部分骨折严重,移位骨块不确定方位的患者行CT检查。采用标准肩关节前外侧切口,经胸大肌和三角肌肌间沟入路,伴肩关节脱位者将肱骨头复位,再将骨折复位,骨缺损或老年患者因骨质疏松骨折时造成空洞,采用自体骨或人工骨填塞支撑,用锁定钢板固定,C臂X线机透视证明骨折对位对线好,修复关节囊及肩袖损伤。结果 本组患者切口均一期愈合,无医源性损伤,随访29例,随访时间8~18个月,X线片示骨折对位对线良好,骨折愈合良好,愈合时间6~12个月。按Neer评分[2]结果:优23例占79.31%,良5例占17.24%,可1例占3.45%,总优良率96.55%。结论 适合肱骨近端特殊的解剖形态,肱骨头固定螺钉向不同的方向交叉设计,提高了内固定物抗拔出力,特别适合于骨质疏松的老年患者;有较好的锚合力和较高的抗拉力,可防止螺钉退出和内固定松动,对肱骨头的支持固定较其它如AO型及普通接骨板得到明显的加强,尤其是对粉碎性骨折,老年患者骨质疏松及其植骨患者良好的稳定固定作用。体积小,板较薄,操作减少对软组织的剥离和刺激,降低了肩峰撞击症的发生率,总之锁定钢板技术的提出和应用可以在最大程度上保护骨端的血运并达到稳定的固定,促进骨痂愈合[2]。由于肱骨近端锁定钢板能青壮年高能量创伤和对老年骨质疏松性骨折的骨折块提供确切的固定,人工关节置换术的适应症已经明显缩小[3]。
[关键词]肱骨骨折;锁定钢板;内固定;治疗
[中图分类号]R683.41[文献标识码]A [文章编号] 1005-0515(2010)-7-0491-02
The Clinical Application Value of Locking Plate Internal Fixation in Treating Fracture of Proximal Humerus
Li GonglunWang GuoruiLongPingZhaoHun
(The Second Surgical Department of No. 478 Military Hospital, Kun Ming 650200,china)
[Abstract]ObjectiveTo explore the new method for treating severe displacement and complicated fracture of proximal humerus caused by high energy trauma in young adults and osteoporosis in the elderly. Methods 32 cases of proximal humerus fracture were treated with locking plate internal fixation from Jan 2008 to Jan 2010 and examined by X-ray radiography (DR) before operation. CT examinations were performed on some patients with severe fracture and uncertain displacement orientation of bones. Standard anterolateral incision of shoulder joint was adopted by interscalene approach between pectoralis major and deltoid. The head of humerus was repositioned first in patients with shoulder joint dislocation and then the fracture. Autogenous or artificial bone was used to fill the cavity caused by bone defect or osteoporosis in the elderly, and the locking plate was used for fixation. Damaged articular capsule and rotator cuff were repaired after good alignment was shown by C-brachial X-ray machine. Results The patients of this group all gained primary healing without iatrogenic injuries. 29 cases were followed up for 8-18 months. X-ray radiography demonstrated good alignment
and fracture healing. The healing time was 6-12 months. According to the Neer scoring [1] result, there were 23 cases of excellence accounting for 79.31%, 5 were good accounting for 17.24%, and 1 not bad accounting for 3.45%. The total rate of good and above good was 96.55%. Conclusions The set screws of humerus are designed as crossing in different directions according to the special anatomical form of proximal humerus to improve anti-pullout force of internal fixation, which is especially suitable for the old patients of osteoporosis; the locking plate has better anchor joint force and stretching resistance to prevent screw dropping and loosening of the internal fixation, which make it enjoy a better securing effect comparing with other kinds of bone plates such as AO type especially for patients with comminuted fracture, osteoporosis and bone grafting. The occurrence rate of acromion impingement is decreased due to its smallness, thinness and less stimulus to soft tissue. In a word, the locking plate can greatly protect blood transport of the epiphysis and offer stable fixation to improve callus healing [2]. Because the locking plate can offer certain fixation for fracture caused by high energy trauma in young adults and osteoporosis in the elderly, the indications for artificial joint replacement has been obviously decreased [3]., http://www.100md.com(李公伦 王国蕊 龙 平 赵 辉 张 涛 杨正清)
[关键词]肱骨骨折;锁定钢板;内固定;治疗
[中图分类号]R683.41[文献标识码]A [文章编号] 1005-0515(2010)-7-0491-02
The Clinical Application Value of Locking Plate Internal Fixation in Treating Fracture of Proximal Humerus
Li GonglunWang GuoruiLongPingZhaoHun
(The Second Surgical Department of No. 478 Military Hospital, Kun Ming 650200,china)
[Abstract]ObjectiveTo explore the new method for treating severe displacement and complicated fracture of proximal humerus caused by high energy trauma in young adults and osteoporosis in the elderly. Methods 32 cases of proximal humerus fracture were treated with locking plate internal fixation from Jan 2008 to Jan 2010 and examined by X-ray radiography (DR) before operation. CT examinations were performed on some patients with severe fracture and uncertain displacement orientation of bones. Standard anterolateral incision of shoulder joint was adopted by interscalene approach between pectoralis major and deltoid. The head of humerus was repositioned first in patients with shoulder joint dislocation and then the fracture. Autogenous or artificial bone was used to fill the cavity caused by bone defect or osteoporosis in the elderly, and the locking plate was used for fixation. Damaged articular capsule and rotator cuff were repaired after good alignment was shown by C-brachial X-ray machine. Results The patients of this group all gained primary healing without iatrogenic injuries. 29 cases were followed up for 8-18 months. X-ray radiography demonstrated good alignment
and fracture healing. The healing time was 6-12 months. According to the Neer scoring [1] result, there were 23 cases of excellence accounting for 79.31%, 5 were good accounting for 17.24%, and 1 not bad accounting for 3.45%. The total rate of good and above good was 96.55%. Conclusions The set screws of humerus are designed as crossing in different directions according to the special anatomical form of proximal humerus to improve anti-pullout force of internal fixation, which is especially suitable for the old patients of osteoporosis; the locking plate has better anchor joint force and stretching resistance to prevent screw dropping and loosening of the internal fixation, which make it enjoy a better securing effect comparing with other kinds of bone plates such as AO type especially for patients with comminuted fracture, osteoporosis and bone grafting. The occurrence rate of acromion impingement is decreased due to its smallness, thinness and less stimulus to soft tissue. In a word, the locking plate can greatly protect blood transport of the epiphysis and offer stable fixation to improve callus healing [2]. Because the locking plate can offer certain fixation for fracture caused by high energy trauma in young adults and osteoporosis in the elderly, the indications for artificial joint replacement has been obviously decreased [3]., http://www.100md.com(李公伦 王国蕊 龙 平 赵 辉 张 涛 杨正清)