三种手术方式治疗Neer Ⅲ-Ⅳ部分肱骨近端骨折的比较Comparison of three surgical techniques for the treatment of Neer grade Ⅲ-Ⅳ proximal humeral fractures
王礼宁;王强;沈婧鈺;黄河;常鹏飞;郭杨;马勇;
摘要(Abstract)：
[目的]比较外侧锁定加内侧辅助钢板与单纯外侧锁定钢板、人工半肩关节置换治疗NeerⅢ-Ⅳ部分肱骨近端骨折的疗效。[方法]回顾性分析2015年11月～2017年1月本科诊治的NeerⅢ-Ⅳ部分肱骨近端骨折53例,其中17例采用外侧锁定加内侧辅助钢板内固定(双钢板组),21例采用单纯外侧锁定钢板固定(单钢板组),15例采用人工半肩关节置换(关节置换组)。比较三组患者的临床与影像资料。[结果]双钢板组在手术时间上长于其余两组,差异有统计学意义(P<0.01),但在术中出血量及切口长度上三组差异无统计学意义(P>0.05)。术后1、3个月双钢板组和单钢板组的Neer评分低于关节置换组,差异有统计学意义(P<0.01);但术后6个月时,三组评分差异无统计学意义(P>0.05);而术后12个月时,双钢板组和单钢板组的Neer评分均高于关节置换组,且差异有统计学意义(P<0.01)。在影像测量方面,肱骨头内翻角和肱骨头高度丢失值在双钢板组和单钢板组均随术后时间延长而增加,不同时间点间差异有统计学意义(P<0.05);双钢板组上述变化显著小于单钢板组,表现为术后1个月和3个月上述影像指标两组间差异无统计学意义(P>0.05),但术后6个月和12个月两组间差异有统计学意义(P<0.05)。[结论]锁定加内侧辅助钢板技术是治疗NeerⅢ-Ⅳ部分肱骨近端骨折的有效方式之一。
关键词(KeyWords)： 肱骨近端骨折;锁定加内侧辅助钢板;半肩关节置换;肩关节Neer评分;内侧柱支撑
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作者(Author): 王礼宁;王强;沈婧鈺;黄河;常鹏飞;郭杨;马勇;
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