文献类型：期刊文献

中文题名：髓内钉内固定术治疗肱骨近端骨折32例疗效观察

英文题名：Efficacy observation on 32 cases of proximal humerus fractures treated with internal fixation by intramedullary nail

作者：魏英俊[1];贾柯[2];徐克武[3]

第一作者：魏英俊

机构：[1]甘肃中医药大学中医临床学院,甘肃兰州730101;[2]宁夏回族自治区第三人民医院骨科,宁夏银川750000;[3]甘肃中医药大学附属医院创伤骨科,甘肃兰州730020

第一机构：甘肃中医药大学中医临床学院

年份：2020

卷号：37

期号：3

起止页码：60

中文期刊名：甘肃中医药大学学报

外文期刊名：Journal of Gansu University of Chinese Medicine

语种：中文

中文关键词：肱骨近端骨折;肩关节;髓内钉内固定术;手术时间;出血量;骨折愈合时间;视觉模拟评分法评分;Constant-Murley肩关节功能评分;临床疗效

外文关键词：proximal humeral fractures(PHF);shoulder joint;internal fixation by intramedullary nail;operation time;blood loss;union time;visual analogue scale(VAS)score;Constant-Murley shoulder joint function assessment scale(CMS);clinical efficacy

摘要：目的回顾性分析髓内钉内固定术治疗肱骨近端骨折的临床疗效。方法选取Neer分型二部分、三部分的肱骨近端骨折患者32例,均采用髓内钉内固定术治疗且获得完整随访。记录患者的手术时间、术中出血量,术后末次随访时的视觉模拟评分法(VAS)评分、肩关节主动活动范围、骨折愈合情况、愈合时间、骨折愈合后颈干角的大小及术后并发症,通过Constant-Murley肩关节功能评分进行疗效评价。结果32例患者平均手术时间为(89.68±19.19)min,术中平均出血量为(83.83±28.09)m L,术中无腋神经或桡神经损伤;术后末次随访时所有患者骨折均获得骨性愈合,骨折愈合时间为(7.28±1.25)个月,愈合后肱骨颈干角(126±4.27)°,末次随访时VAS评分(1.37±0.68)分,肩关节前屈上举(143.66±24.65)°、外展上举(133.37±21.58)°、内旋(47.63±9.68)°、外旋(21.21±4.28)°,Constant-Murley肩关节功能评分(81.74±3.21)分。疗效评定结果优4例,良21例,可4例,差3例,优良率为78.13%。随访过程中3例患者发生切口浅表感染,1例发生肩峰下撞击征,经过相应处理均取得满意的疗效。结论髓内钉内固定术治疗Neer分型二部分、三部分的肱骨近端骨折疗效确切,且手术时间短、术中出血量少、骨折愈合时间短、术后并发症少,患者术后可早期进行肩关节功能锻炼,是治疗肱骨近端骨折较理想的一种术式。
Objective To make a retrospective analysis of the clinical efficacy of proximal humerus fractures(PHF)treated with internal fixation by intramedullary nail.Methods According to Neer typing,32 patients with typeⅡand typeⅢPHF were chosen and treated with internal fixation by intramedullary nail and a complete followup was obtained.The operation time,intraoperative blood loss,visual analogue scale(VAS)score,active range of motion of the shoulder joint,fracture healing,healing time,the size of collodiaphyseal angle after union and postoperative complications were recorded at the last postoperative follow-up,the curative effect was evaluated by Constant-Murley shoulder joint function assessment scale(CMS).Results The average operation time of 32 patients was(89.68±19.19)min,the average intraoperative blood loss was(83.83±28.09)m L,no axillary or radial nerve injury during operation.At the last postoperative follow-up,all patients got bony union.The time of union was(7.28±1.25)months,and humeral collodiaphyseal angle after union was(126±4.27)°.At the last follow-up,VAS score was(1.37±0.68)score,shoulder joint forward elevation was(143.66±24.65)°,abduction forward elevation was(133.37±21.58)°,internal rotation was(47.63±9.68)°,external rotation was(21.21±4.28)°,CMS score was(81.74±3.21)score.The results of efficacy evaluation was excellent in 4 cases,good in 21 cases,fair in 4 cases and poor in 3 cases,with the excellent and good rate of 78.13%.During the follow-up,superficial incision infection occurred in 3 patients and subacromial impingement syndrome occurred in 1 patient.Satisfactory curative effect was achieved after corresponding treatment.Conclusion It has definite efficacy to use internal fixation by intramedullary nail in the treatment of typeⅡand typeⅢPHF according to Neer typing with short operation time,less intraoperative blood loss,short union time and less postoperative complications.Patients can exercise shoulder joint function early after operation.It is an ideal operation for the treatment of PHF.