Wang Xiaopeng, Tang Xiaoyu, Feng Jian, Zou Yiyuan, Zheng Xinbo
Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China.
Department of Upper Limb, No.1 Orthopedics Hospital of Chengdu, Chengdu Qingyang District Medical Center Hospital, Chengdu Sichuan, 610073, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jul 15;35(7):818-822. doi: 10.7507/1002-1892.202103173.
To investigate the effectiveness of limited open reduction via "door-shaft method" and internal fixation with locking plate for two- and three-part fractures of the proximal humerus.
The clinical data of 64 patients with proximal humeral fractures who were admitted between January 2013 and December 2016 and met the selection criteria were retrospectively analyzed. There were 23 males and 41 females, with an average age of 68.0 years (range, 50-89 years). The injuries were caused by falling in 57 cases, traffic accident in 5 cases, and falling from height in 2 cases. The interval between injury and operation was 1-7 days (mean, 2.1 days). According to Neer classification, there were 28 cases of two-part fractures and 36 cases of three-part fractures. According to the angulation direction of the proximal humeral neck shaft angle, there were 21 cases of adduction fractures and 43 cases of abduction fractures. The fractures were treated with limited open reduction via "door-shaft method" and proximal humerus internal locking systems for internal fixation. The operation time, intraoperative blood loss, number of fluoroscopy, hospital stay, and complications were recorded. The fracture healing was reviewed by X-ray film and the healing time was recorded. The shoulder joint function was evaluated by Neer score standard.
The operation time was 45-127 minutes, with an average of 82.3 minutes. The intraoperative blood loss was 30-125 mL, with an average of 62.7 mL. Intraoperative fluoroscopy was performed 30-69 times, with an average of 37.0 times. The hospital stay was 6-23 days, with an average of 10.3 days. All incisions healed by first intention. All patients were followed up 12-37 months, with an average of 18.3 months. X-ray film re-examination showed that all fractures healed, the healing time was 12-21 weeks, with an average of 14.3 weeks. After operation, 3 cases had shoulder stiffness and 1 case had fracture malunion. At last follow-up, the Neer score of shoulder joint function was 49-97, with an average of 83.1. Among them, 38 cases were excellent, 13 cases were good, 10 cases were fair, and 3 cases were poor. The excellent and good rate was 79.7%. The excellent and good rate of patients with two-part fractures was 82.1% (23/28), and the excellent and good rate of patients with three-part fractures was 77.8% (28/36).
The "door-shaft method" not only reduces the difficulty of the Joystick technique in the reduction of proximal humerus fractures, but also provides auxiliary stability. It is used for limited open reduction and internal fixation with locking plate to treat the two- and three-part fractures of the proximal humerus, which can achieve good effectiveness.
探讨采用“门轴法”有限切开复位及锁定钢板内固定治疗肱骨近端二、三部分骨折的疗效。
回顾性分析2013年1月至2016年12月收治的64例符合入选标准的肱骨近端骨折患者的临床资料。其中男23例，女41例，平均年龄68.0岁（50 - 89岁）。致伤原因：跌倒57例，交通事故5例，高处坠落2例。受伤至手术时间为1 - 7天（平均2.1天）。按Neer分型：二部分骨折28例，三部分骨折36例。按肱骨近端颈干角成角方向：内收型骨折21例，外展型骨折43例。采用“门轴法”有限切开复位，应用肱骨近端锁定系统内固定治疗骨折。记录手术时间、术中出血量、透视次数、住院时间及并发症。通过X线片复查骨折愈合情况并记录愈合时间。采用Neer评分标准评估肩关节功能。
手术时间45 - 127分钟，平均82.3分钟。术中出血量30 - 125 mL，平均62.7 mL。术中透视30 - 69次，平均37.0次。住院时间6 - 23天，平均10.3天。所有切口均一期愈合。所有患者随访12 - 37个月，平均18.3个月。X线片复查显示所有骨折均愈合，愈合时间12 - 21周，平均14.3周。术后3例出现肩关节僵硬，1例骨折畸形愈合。末次随访时肩关节功能Neer评分为49 - 97分，平均83.1分。其中优38例，良13例，可10例，差3例。优良率为79.7%。二部分骨折患者优良率为82.1%（23/28），三部分骨折患者优良率为77.8%（28/36）。
“门轴法”既降低了肱骨近端骨折复位中操纵杆技术的难度，又提供了辅助稳定性。采用该方法有限切开复位联合锁定钢板内固定治疗肱骨近端二、三部分骨折，可取得良好疗效。
