【摘要】 背景:肱骨近端骨折内固定能提供更稳定的固定,具有更强的生物力学稳定性,但切开复位固定造成软组织剥离广泛,肩袖破坏重。闭合穿钉固定失败率高、骨折再移位等缺陷。目的:探讨应用闭合复位、经皮穿针解剖型外固定支架修复肱骨近端骨折的技术方法,分析其在不同类型肱骨近端骨折中的应用特点及安全性。方法:作者针对肱骨近端特殊的解剖结构,自主研发了一种肩关节外固定支架。回顾性分析2010年3月至2014年3月在天津医院创伤科因肱骨近端骨折行闭合复位、经皮穿针解剖型外固定支架(自制)治疗的23例患者的临床资料,依照Neer分型,其中肱骨2部分骨折19例,3部分4例,伴有大结节撕脱骨折,均为新鲜骨折,均采用闭合复位穿针,外固定支架固定。治疗后定期随访,随访期间进行影像学评估、疼痛及功能评价,得出功能恢复情况,确定最终修复效果。结果与结论:全部病例均获得随访,随访时间6-24个月,23例患者均在8周内初步骨折愈合。治疗后患者疼痛目测类比评分为0.8分。末次随访患者平均美国肩肘外科协会肩关节功能评分系统(ASES)评分为(91.7±2.6)分,Constant肩关节功能评分平均为(88.3±4.7)分,美国加州大学肩关节评分系统(UCLA)评分为(31.9±3.1)分,简明肩关节功能测试(SST)系统评分平均为(9.6±2.4)分。12例患者肩关节功能(UCLA评分)评估为优,良9例,差2例,治疗后优良率达91%。提示应用闭合复位、经皮穿钉解剖型外固定支架修复肱骨近端骨折具有固定稳定、软组织损伤小的特点。规范闭合穿钉的角度及进钉点,从三平面交汇固定,呈弓状固定,与外固定支架连接能达到较稳定的固定效果。更多还原

【Abstract】 BACKGROUND: Proximal humeral fracture fixation can provide a more stable fixation,has a stronger biomechanical stability,but open reduction and fixation will cause extensive soft tissue dissection and heavy damage to the rotator cuff.Closed wear nail has a high failure rate of fixation,fracture re-displacement and other defects.OBJECTIVE: To investigate the technical methods of applying closed reduction,percutaneous pinning anatomical external fixation in repair of proximal humeral fracture,and to analyze the application characteristicsand safety in different types of proximal humerus fractures.METHODS: Based on the special anatomical structure of proximal humerus,a shoulder external fixator has been independently researched and developed by author.The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation(homemade) because of proximal humerus fracture at the Department of Traumatology,Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed.In accordance with Neer classification type,there were 19 cases of 2-part fractures of the humerus,4 cases of 3-parts fractures of the humerus,with greater tuberosity avulsion fractures,which were all fresh fractures and were treated with closed reduction pinning and external fixation.Regular follow-up was conducted after treatment.Radiographic assessment,pain and function evaluation were conducted during follow-up,so as to work out the functional recovery,determine the final repair result.RESULTS AND CONCLUSION: All patients were followed up for 6-24 months.Totally 23 patients initially healed in fracture within 8 weeks.After treatment,visual analogue pain score of patients was 0.8 points.In the final follow-up,the American Shoulder and Elbow Surgery Association of shoulder function scoring system(ASES) score was an average of(91.7±2.6) points,Constant shoulder function score was an average of(88.3±4.7) points,the University of California(UCLA) shoulder joint scoring system score was(31.9±3.1) points,simple shoulder test(SST) system score was an average of(9.6±2.4) points.The shoulder function assessment(UCLA score) of these 12 patients was excellent,of 9 cases was good,and of 2 cases was poor.The excellent rate reached 91% after treatment.These results suggest that the application of closed reduction,percutaneous nailing anatomical external fixation in repair of proximal humerus fractures has the features of stable fixation,and small damage of soft tissue.Standardizing the angle of closed nailing and entrance point,fixing from the intersection of three planes in arcuate-shape and connecting with external fixation can achieve a more stable fixed effects.更多还原