足部X形AO锁定钢板治疗肱骨大结节骨折

摘要

目的 探讨足部X形AO锁定钢板治疗肱骨大结节骨折的临床疗效.方法 对2009年5月至2010年9月我院应用足部X形AO锁定钢板治疗的19例肱骨大结节骨折患者进行回顾性分析.所有病例均为闭合性损伤且骨折移位均＞5 mm,其中11例伴肩关节前脱位,受伤到手术时间为2～5 d(平均3.5 d).对骨折愈合时间、术后肩关节Constant评分、并发症等进行随访研究.结果 19例患者均获随访,随访时间6～22个月,平均17.2个月.平均骨折愈合时间为9.4周(8～14周).Constant评分为90.6±4.0分(77～95分),其中优16例(84.2％),良2例(10.5％),中1例(5.3％),差0例,优良率达94.7％.11例大结节骨折伴肩关节脱位者均未发生再次脱位,所有病例均无切口感染、局部皮肤麻木、肩峰下撞击、骨不愈合、大结节再移位、内固定松动等并发症.结论 足部X形AO锁定钢板治疗单纯肱骨大结节骨折可获得满意疗效,具有血供破坏少、骨折固定稳定和早期活动等优点,是一种安全、有效的治疗方法.%Objective To evaluate the efficiency of X-shaped AO midfoot locking plates for the greater tuberosity fractures of the proximal humerus. Methods A retrospective study was conducted for the 19 patients with displaced greater tuberosity fractures which had been treated by open reduction internal fixation (ORIF) with X-shaped AO midfoot locking plates from May 2009 to September 2010. All patients who had sustained isolated greater tuberosity fractures with a displacement of more than 5 mm, and 11 cases also with an anterior shoulder dislocation. The injury to the operation time was 2 to 5 days (an average of 3. 5 days). The Follow-up study includes the fracture healing time, postoperative complication, and shoulder functional results (which defined by Constant score). Results All the patients were followed up for a mean period of 17.2 months (6-22 months). The mean healing time was 9.4 weeks (8-14 weeks). The Constant score was 90. 6 ± 4. 0 points (77 to 95 points). Evaluation excellent for 16 cases, good for 2 cases, mild in one, no poor result, the excellent-good rate was 94. 7%. Eleven cases with shoulder dislocation were not happened again. All fractures healed without complications of wound infection, numbness of skin, subacromial impingement syndrome, nonunion, secondary displacement and implant failure. Conclusions The treatment with X-shaped AO midfoot locking plates for the greater tuberosity fractures showed satisfactory results. It has less damage to the blood supply, can provide stable fixation during the healing process and allow early rehabilitation exercise. So it is considered as a safe and effective method.