| 翁蔚宗,张 军,曹烈虎,周启荣,苏佳灿,纪 方.采用同种异体腓骨植骨重建肱骨近端内侧柱的临床应用及疗效[J].,2017,17(5):844-848 |
| 采用同种异体腓骨植骨重建肱骨近端内侧柱的临床应用及疗效 |
| The Clinical Efficiency of Fibular Allograft for the Medial Column Reconstruction of Proximal Humeral Fractures |
| 投稿时间：2016-09-30 修订日期：2016-10-15 |
| DOI：10.13241/j.cnki.pmb.2017.05.010 |
| 中文关键词: 肱骨近端骨折 同种异体腓骨 植骨 内侧柱 康复 |
| 英文关键词: Proximal humeral fracture Allograft fibula Bone graft The medial column Recovery |
| 基金项目:国家自然科学基金项目（31271031）；国家自然科学基金国际重大合作项目（8141101156） |
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| 中文摘要: |
| 摘要 目的：探讨同种异体腓骨移植重建肱骨近端内侧柱联合锁定钢板治疗肱骨近端骨折的临床疗效。方法：回顾性分析2011年3月至2013年9月于我院行同种异体腓骨移植联合锁定钢板治疗肱骨近端骨折患者38例。根据Neer分型：三部分骨折26例，四部分骨折12例；随访期间测量肱骨头内翻角度、肱骨头高度；患肩功能评分采用Constant肩关节评分标准、美国肩肘协会评分系统（ASES）及加州大学肩关节评分系统（UCLA），同时记录患者并发症。结果：患者随访时间平均15.5±1.8个月；末次随访Constant肩关节评分平均89.0±3.2分；美国肩肘协会评分系统（ASES）评分为平均81.2±14.5分；加州大学肩关节评分系统（UCLA）平均27.6±5.3；根据UCLA评分系统，患者术后优良率为89.4%。患侧肩关节前屈、外展、外旋及内旋运动范围分别是143±20°、138±9°、44±12°、42±9°。影像学结果显示：末次随访肱骨头高度平均丢失1.9 mm，颈干角度平均为128±16°。根据Paavolainen方法，末次随访优30例、良7例、差1例。结论：同种异体腓骨移植重建肱骨近端骨折内侧柱，术中联合肱骨近端锁定钢板能有效支撑肱骨头，预防肱骨头塌陷及螺钉穿出，短期临床疗效满意。 |
| 英文摘要: |
| ABSTRACT Objective: To evaluate the clinical effects of the medial column reconstruction using fibular allograft combined with locking-plate on proximal humeral fractures. Methods: From March 2011 to September 2013, 38 patients with proximal humeral fractures treated by fibular allograft combined with locking-plate were included. 26 cases were diagnosed with Neer Type III, and 12 Neer Type IV. For functional evaluation, the Constant score, American Shoulder and Elbow Society (ASES) score and the University of California, Los Angeles (UCLA) score were used. Complications such as postoperative infection, humeral head inversion and screw cutting were recorded. Results: 38 patients were followed up for 13-18 months. At final follow-up, the average Constant, ASES and UCLA scores were 89.0±3.2, 81.2±14.5 and 27.6±5.3, respectively. According to the UCLA scoring system, the result was yielded with an Excel- lent-good rate of 89.4%. For the range of motion (ROM), the mean forward flexion, abduction, external rotation, and internal rotation were 143±20°, 138±9°, 44±12° and 42±9°. According to the radiograph, the mean loss of the height of humeral head was 1.9 mm and the neck-shaft angle was 128±16°. According to the Paavolainen method, the result was good in 30 cases, fair in 7 cases and poor in 1 case on final follow-up. Conclusion: Fibular allograft for the medial column reconstruction combined with locking plate can ef- fectively support the humeral head and prevent the collapse of the humeral head and screw cutting-out in the surgical treatment of proxi- mal humeral fractures. The short-term clinical efficacy was satisfactory. |
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