作　　者： (郭伟军）; (陈林）; (赵友明）; (张伟江）; (汪吉棋）;

机构地区： 温州医科大学附属第二医院、育英儿童医院骨科,325000

出　　处： 《中华创伤杂志》 2017年第9期823-828,共6页

摘　　要： 目的探讨锁定钢板治疗肱骨近端骨折时颈干角变化及其临床意义。方法采用回顾性病例对照研究分析2008年1月一2016年6月应用锁定钢板治疗的214例肱骨近端骨折患者临床资料。根据有无内侧骨缺损将患者分为两组：伴内侧骨缺损组85例，其中男35例，女50例；平均年龄63．3岁。其中Neer分型三部分骨折47例，四部分骨折38例。不伴内侧骨缺损组129例，其中男51例，女78例；平均年龄65．9岁。其中Neer分型三部分骨折57例，四部分骨折72例。比较术前对侧、术后1d、1，3，6，12个月x线片肱骨颈干角变化，采用Constant评分评价肩关节功能。结果214例患者术后获随访12～42个月，平均24．2个月。伴内侧骨缺损组术前对侧、术后1d，术后1，3，6，12个月颈干角分别为（133．4±4．0）°、（134．7±11．5）°、（120．8±4．0）°、（118．5±3．5）°、（117．9±10．4）°、（114．7±4．4）°；不伴内侧骨缺损组分别为（134．0±2．4）°、（133．8±17．1）°、（135．6±2．9）°、（132．7±2．8）°、（131．5±13．5）°、（135．2±2．8）°。两组术后1，3，6，12个月的颈干角比较差异有统计学意义（P〈0．05），伴内侧骨缺损组术前与术后1d颈干角差异无统计学意义（P〉0．05），但两者均大于其余各时相点（P〈0．05）；而不伴内侧骨缺损组中，除术后1个月与术后6个月的颈干角之间差异有统计学意义（P〈0．05）外，其余各时相点比较差异均无统计学意义（P〉0．05）。伴内侧骨缺损组和不伴内侧骨缺损组Constant评分分别为（69．3±14．6）分、（75．2±12．6）分（P〈0．05）。结论正常颈干角恢复后仍需注意术后颈干角的丢失。肱骨颈干角可以为术前手术方案及术后功能锻炼计划的制订提供依据，指导术中解剖复位以及评估术后疗效。此外，颈干角的丢失受到内侧支撑的影响，并进� Objective To investigate the changes and clinical significance of neck-shaft angle in the treatment of proximal humerus fractures with locking plate. Methods A retrospective case-control study was done on 214 cases of proximal humerus fractures treated with locking plate in our hospital from January 2008 to June 2016. According to the presence of medial bone defects, the cases were divided into medial bone defect group （85 cases） and non-medial bone defect group （129 cases）. In medial bone defect group, there were 35 males and 50 females, with an average age of 63.3 years old. In this group, the cases of Neer three-part fractures and Neer four-part fractures were 47 and 38, respectively. In non- medial bone defect group, there were 51 males and 78 females, with an average age of 65.9 years old. In this group, the cases of Neer three-part fractures and Neer four-part fractures were 57 and 72, respectively.The preoperative humeral neck-shaft angle of contralateral humerus, and the humeral neck-shaft angle with its changes on the second postoperative day as well as 1, 3, 6 and 12 months after surgery were evaluated by the X-ray film. The Constant scores of the shoulder function were also assessed. Results The follow-up time for the patients ranged from 12 to 42 months （mean 24.2 months）. In medial bone defect group, the preoperative neck-shaft angle of contralateral humerus, as well as neck-shaft angles of fractured side at five follow-up visits were （ 133.4±4.0）°, （ 134.7±11.5 ）°, （ 120.8 ±4.0）°, （ 118.5±3.5 ）°, （ 117.9±10.4）° and （ 114.7±4.4）°, respectively. While in the other group, the corresponding parameters were （134.0±2.4）°, （133.8±17. 1）°, （135.6± 2.9）°, （132.7± 2.8 ）°, （ 131.5±13.5 ）°, （ 135.2±2.8 ）°, respectively. There were significant differences between the two groups of the neck-shaft angle at 1, 3, 6 and 12 months（P 〈0.05） . In the medial bone defect group, there were no significant differences between neck-shaf

关 键 词： 肱骨骨折 骨折内固定 内 肱骨颈干角