许华亮;李爱国;赖敏锋;陈泳格;陈鸿辉;

• 1:暨南大学医学院附属广州红十字会医院骨科

摘要(Abstract)：

[目的]总结应用经皮微创与切开复位钢板内固定治疗肱骨近端骨折的临床效果。[方法]对2014年1月~2014年12月手术治疗并获得随访的57例肱骨近端骨折患者进行回顾性分析,其中27例行经皮微创钢板内固定,男9例,女18例;年龄70.5(51.4~89.5)岁,按照Neer分型,二部分骨折14例,三部分骨折11例,四部分骨折2例;30例行切开复位钢板内固定,男11例,女19例,年龄69.5(52.3~86.8)岁,按照Neer分型,二部分骨折13例,三部分骨折14例,四部分骨折3例。从手术相关指标、患侧Neer肩关节功能评分及术后并发症情况3个方面对两种治疗方法进行比较分析。[结果]:57例患者获得随访,时间13~24个月,平均17.8个月。术后出现感染、腋神经损伤、肱骨头坏死各1例,内固定失效3例。经皮微创组手术切口长度、术中出血量、住院天数、骨折愈合时间均优于切口组,两组间差异有统计学意义(P<0.05),而手术时间比较两组差异无统计学意义(P>0.05)。术后并发症的发生率两组比较差异无统计学意义(P>0.05),术后12个月的肩关节功能Neer评分两组比较差异无统计学意义(P>0.05)。[结论]:经皮微创钢板内固定治疗肱骨近端骨折具有创伤小、骨折愈合快等特点。

关键词(KeyWords)： 肱骨近端骨折;经皮微创钢板内固定;腋神经

Abstract:

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作者(Author): 许华亮;李爱国;赖敏锋;陈泳格;陈鸿辉;

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参考文献(References)：

• [1]Helmy N,Hintermann B.New trends in the treatment of proximal humerus fractures[J].Clin Orthop,2006,442(442):100-108.
• [2]Khatib O,Onyekwelu I,Zuckerman JD.The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older[J].J Shoulder Elbow Surg,2014,23(9):1356-1362.
• [3]Barlow JD,Sanchez-Sotelo J,Torchia M.Proximal humerus fractures in the elderly can be reliably fixed with a“hybrid”lockedplating technique[J].Clin Orthop,2011,469(469):3281-3291.
• [4]蔡俊丰,李增春,尹峰,等.肩峰下前外侧小切口入路在肱骨近端骨折治疗中的临床应用[J].中国矫形外科杂志,2010,18(4):284-287.
• [5]赵弟庆,张丽娜,杨广忠,等.MIPPO技术结合PHILOS治疗老年骨质疏松性肱骨近端骨折[J].中国矫形外科杂志,2014,22(6):508-511.
• [6]庞彬,钟传礼,翁玄.经皮微创接骨板及切开复位内固定术治疗肱骨近端骨折的对照研究[J].现代医药卫生,2016,32(2):242-244.
• [7]Chen YF,Zhu NF,Zhang CQ,et al.The relevance of the anatomical basis of fracture for the subsequent treatment of the anterior humeral circumflex artery and the axillary nerve[J].Int Orthop(SICOT),2012,36(4):783–787.
• [8]朱乃锋,张睿,陈云丰,等.肱骨近端骨折手术安全区的解剖学研究和临床意义[J].中国临床解剖学杂志,2011,29(2):168-170.
• [9]Gardner MJ,Grimth MH,Dines JS,et al.The extended anterolateralaeromial approach allows minimally invasive access to the proximal humerus[J].Clin Orthop,2005,434(434):123-129.
• [10]Lin T,Xiao BJ,Ma XC,et al.Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures[J].BMC Musculoskeletal Disorders,2014,15(1):206.
• [11]Cheung S,Fitzpatrick M,Lee T Q,et a1.Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach[J].J Shoulder Elbow Surg,2009,18(5):748—755.
• [12]陈雨,袁锋.肱骨近端手术安全区解剖学特点及其临床意义[J].临床骨科杂志,2015,18(6):740-743.
• [13]Zhang L,Zheng JY,Wang WL,et al.The clinical benefit of medial support screws in locking plating of proximal humerus fractures:a prospective randomized study[J].Int Orthop(SICOT),2011,35(11):1655–1661.
• [14]Jung et al.Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate[J].BMC Musculoskeletal Disorders,2013,14(1):102.
• [15]Schliemann B,Wahnert D,Theisen C,et al.How toenhance the stability of locking plate fixation of proximal humerus fractures?An overview of current biomechanical and clinical data[J].Injury,2015,7(7):1207–1214.
• [16]Wagner M,Frigg R.内固定支架—理念及LCP、LISS的临床应用[M].刘璠,陶然,译.济南:山东科技出版社,2010:159-160.