【作者】 刘亮；

【导师】 盛加根；

【作者基本信息】 苏州大学 ， 临床医学（专业学位）， 2015， 硕士

【摘要】 目的探讨外固定支架在肱骨近端骨折切开复位内固定中的临时应用价值。方法自2012年7月至2014年1月采用三角肌胸大肌间隙入路切开复位钢板内固定治疗肱骨近端骨折22例,男8例,女14例;年龄33~76岁,平均52岁;左侧13例,右侧9例。采用Neer骨折分类法,Neer二部分骨折5例,均为外科颈骨折:Neer三部分骨折13例,其中合并肩关节前脱位3例;Neer四部分骨折4例,其中合并肩关节前脱位1例。术中使用单边外固定支架临时辅助复位固定,采用肱骨近端锁定钢板内固定系统(PHILOS,瑞士Synthes公司)内固定。术后测量肱骨颈干角,采用Constant肩关节功能评分评定肩关节功能。结果随访时间为8~21个月,平均12个月,术后X线评估肱骨颈干角为133.3°±6.9°。发生肱骨头坏死3例,内翻畸形1例。Constant肩关节功能评为82.9±8.1分,优良17例,占77%,可为4例,占18%,差为1例,占5%。其中Neer二部分骨折优良率为100%,无肱骨头坏死;Neer三部分骨折优良率为77%,无差的病例,肱骨头坏死发生率为15%;Neer四部分骨折优良率为50%,差为25%,肱骨头坏死率为25%。结论在肱骨近端骨折切复内固定中临时应用单边外固定支架辅助复位固定效果肯定,术后早期合理的功能锻炼,可取得满意的治疗结果。更多还原

【Abstract】 Objective: To evaluate The value of using external fixator temporarily in the ORIF treatment of the proximal humeral fracturesMethods: From July 2012 to January 2014,22 cases with proximal humeral fractures underwent operation through the deltopectoral approach.8 men and 14 women with a mean of 52 years(33 to 76).13 cases on the left side,9 cases on the right side.According to the Neer classification,two-part fractures were diagnosed in 5 cases,three-part fractures in 13 cases,four-part fractures in 4 cases. All patients were using external fixator temporarily in the open reduction locking plate internal fixation.Neck-shaft angle detected by the follow-up X-ray film.Constant rating system were adopted to evaluate postoperative functions.angle between epiphysis and diaphysis of the humerusResults: 22 patients got final follow-up, mean follow-up time was 12 months(range from 8 to 21 months).The neck-shaft angle was 133.3°±6.9°.The Constant score was 82.9±8.1 points.The excellent and good rate was 77%(17/22), fair 18%(4/22), and poor 5%(1/22).In two-part fractures, 100% cases were excellent or good results, no humeral head necrosis;In three-part fractures,77% cases were excellent or good results,no poor, 15% were found with humeral head necrosis;In four-part fractures, 50% cases were excellent or good results 25% poor, and 25% were found with humeral head necrosis.Conclusions: The value of using external fixator temporarily in the ORIF treatment of the proximal humeral fractures is effective.A good clinical result can be obtained on proper post-operative rehabilitation.更多还原