羟基磷灰石表面喷涂锁定螺钉锁定钢板治疗骨质疏松性肱骨近端骨折.docVIP

羟基磷灰石表面喷涂锁定螺钉+锁定钢板治疗骨质疏松性肱骨近端骨折 饶根云 陈大勇 周友良 [摘要] 目的 探讨羟基磷灰石表面喷涂锁定螺钉+锁定钢板治疗骨质疏松性肱骨近端骨折的疗效。 方法 2009年1月-2010年6月，收治的17例骨质疏松性肱骨近端粉碎性骨折患者，X线片及三维CT重建表现为移位短缩，经肩关节前入路进入复位后，对仍有明显骨质缺损的部位行人工骨植骨，使用锁定钢板+带羟基磷灰石表面喷涂的锁定螺钉治疗固定骨折。术后吊带悬吊，3周后功能锻炼。结果 17例均获得随访，随访时间6个月-23个月，平均13.5月。肩关节外展超过90°，能提物，X线片均无肱骨头坏死，骨折对位对线良好，按Neer功能评分标准，优14例，良3例。结论 对于骨质疏松，骨质缺损严重肱骨近端骨折患者，普通锁定钢板固定不可靠者，可行锁定钢板+带羟基磷灰石表面喷涂的锁定螺钉治疗固定骨折，疗效可靠。 [关键词] 肱骨骨折 骨质疏松 锁定钢板 羟基磷灰石 Treatment of proximal humeral fractures in osteoporosis patients with locking-plate Raogenyun Chendayong zhouyouliang Department of Orthopedics, Branch hospital of Shanghai Traffic University Affliated First Hospital. Shanghai 200081, China [Absract] Objective To study the efficacy of treatment of proximal humeral fractures in osteoporosis patients with locking-plate. Methods 17 osteoporosis patients with serious proximal humeral fractures were admitted from 2009. 1 to 2010. 6. their X-ray and CT revealed displacement and crispation. After anterior reduction through the shouder joint, the obvious osseous defects were filled with men-made bone. Then the fractures were fixed with locking-plates. Sling was applied for the patients postoperatively and the rehabilitation program started 3 weeks after operation. Results All the 17 cases were followed up. The follow-up ranged from 6 to 23 months with an average of 13.5 months. The range of motion was satisfactory with a mean abduction over 90 degrees. X-ray revealed that no patient demonstrated osteonecrosis of the humeral head. Union was achieved in all the patients. According to Neers,scale, the fuction of shouder was excellent in 14 cases, and good in 3 cases. Conclusion This methods is recommended for osteoporosis patients, serious osseous defects and difficulty of using locking-plate, becouse it is reliable 肱骨近端骨折在临床上比较常见，占全身骨折的4%-5%，而骨质疏松患者又占其中67%。骨质疏松、严重粉碎等因素给临床治疗提出了一些难题。锁定钢板的出现改善了部分临床效果，但在骨质疏松患者，仍然出现比较多的锁定螺钉切割、拔除，造成固定失败，骨折再移位，骨折不愈合及畸形愈合，导致肩关节疼痛、活动受限、上肢活动无力。 资料与方法 一般资料 本组17例，男，6例，女，11例；年龄67-86