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“三位一体”骨修复策略治疗老年骨质疏松性肱骨近端骨折的临床疗效
吴银生1,尤炯鸣1,王勇1*,陈晓2,盛世豪2,张涛2,张磊3
0
(1. 温州市中西医结合医院骨科, 温州 325000;
2. 海军军医大学(第二军医大学)第一附属医院骨科, 上海 200433;
3. 中国人民解放军联勤保障部队第九〇六医院骨科, 温州 325000
*通信作者)
摘要:
目的 探讨采用“三位一体”骨修复策略治疗老年骨质疏松性肱骨近端骨折的临床疗效。方法 采用回顾性病例研究,分析2019年4月―2020年5月温州市中西医结合医院收治的28例采用“三位一体”骨修复策略治疗的老年骨质疏松性肱骨近端骨折患者的临床资料。记录患者的骨折愈合时间、颈干角变化。末次随访时采用美国加利福尼亚大学洛杉矶分校(UCLA)肩关节评分评价肩关节功能,记录双侧关节活动度和并发症情况。结果 28例患者中男8例、女20例,年龄为65~86(71.7±6.0)岁;二部分骨折10例,三部分骨折14例,四部分骨折4例;随访时间9~12个月,平均10.5个月。28例患者随访期间均获得骨性愈合,平均愈合时间为(12.6±1.5)周,平均颈干角为(133.1±5.6)°。平均UCLA评分为(31.1±4.1)分。患侧肩关节平均前屈上举、外展、外旋角度分别为(132.5±7.7)°、(116.5±7.0)°、(40.3±3.5)°,内旋至L2/3,与健侧[(169.5±7.3)°、(157.5±6.9)°、(52.1±4.2)°,内旋至T11/12]相比,差异有统计学意义(P<0.05)。28例患者中1例出现螺钉穿出,并发症发生率为3.6%。结论 采用“三位一体”骨修复策略治疗老年骨质疏松性肱骨近端骨折的骨折愈合率高、手术并发症少、肩关节功能恢复好,临床疗效满意。
关键词:  肩骨折  骨质疏松性骨折  内固定器  三位一体
DOI:10.16781/j.CN31-2187/R.20220027
投稿时间:2022-01-09修订日期:2023-03-29
基金项目:
Efficacy of “three-in-one” bone repair strategy for osteoporotic proximal humeral fractures in elderly patients
WU Yinsheng1,YOU Jiongming1,WANG Yong1*,CHEN Xiao2,SHENG Shihao2,ZHANG Tao2,ZHANG Lei3
(1. Department of Orthopaedics, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325000, Zhejiang, China;
2. Department of Orthopaedics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
3. Department of Orthopaedics, No. 906 Hospital of Joint Logistics Support Force of PLA, Wenzhou 325000, Zhejiang, China
*Corresponding author)
Abstract:
Objective To investigate the clinical effect of “three-in-one” bone repair strategy in the treatment of osteoporotic proximal humeral fractures in elderly patients. Methods A retrospective case-control study was conducted to analyze the clinical data of 28 elderly osteoporotic patients with proximal humeral fractures treated with “three-in-one” bone repair strategy in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from Apr. 2019 to May 2020. The fracture healing time and neck-trunk angle were recorded. At the last follow-up, shoulder function was evaluated by the University of California Los Angeles (UCLA) shoulder score, bilateral range of motion and complications were observed as well. Results There were 8 males and 20 females, aged 65-86 (71.7±6.0) years. There were 10 patients with Neer’s two-part fracture, 14 three-part fracture, and 4 four-part fracture. All patients were followed up for 9-12 months, with an average of 10.5 months. Bone union was achieved in 28 patients with a mean healing time of (12.6±1.5) weeks and a mean cervix-trunk angle of (133.1±5.6)°. The average UCLA shoulder score was (31.1±4.1). The mean uplift, abduction, and external rotation angles of the injured side shoulder joint were (132.5±7.7)°, (116.5±7.0)°, and (40.3±3.5)°, and the internal rotation reached L2/3. The mean uplift, abduction, and external rotation angles of the healthy side shoulder joint were (169.5±7.3)°, (157.5±6.9)°, and (52.1±4.2)°, and the internal rotation reached T11/12. The difference of range of motion between the 2 sides was statistically significant (P<0.05). Screw cut-out occurred in 1 patient, with a complication rate of 3.6%. Conclusion For the elderly patients with osteoporotic proximal humeral fracture, “three-in-one” bone repair strategy shows high bone union rate, low surgical complication rate, good recovery of shoulder joint function, and satisfied clinical results.
Key words:  shoulder fractures  osteoporotic fractures  internal fixators  three-in-one