以脛骨平台結構性異體骨與鋼板固定治療近端肱骨骨折

簡介：近端肱骨骨折是老年人常見的骨折，經過手術使用鋼板固定後仍會有復位失效造成內翻彎曲的問題存在。使用結構性腓骨移植治療近端肱骨骨折對於增強結構穩定性有顯著的幫助，但捐贈的腓骨來源有限，膝關節置換手術後切除的脛骨平台取得相對容易。方法：從2011年至2014年，收集85例移位性近端肱骨骨折，接受開放式復位手術治療及鋼板內固定，隨機分配為是否有合併使用結構性異體骨移植。結構性異體骨取自於膝關節置換手術後的脛骨平台，置入肱骨髓腔內。從X光片上測量頭幹角(head-shaft angle)變化，統計並分析結果。結果：有使用結構性異體骨移植的分組一其手術後一個月的頭幹角減少角度平均為9.25度，小於沒有使用結構性異體骨移植的分組二其頭幹角減少角度平均為15.4度，根據統計分析其差距是有意義的(P值小於0.05)。手術後六個月的頭幹角減少角度與手術後一個月並沒有顯著變化。結論：從全膝關節置換手術所取得的脛骨平台作為結構性異體骨移植可減少內翻變形，可以做為腓骨結構性異體骨移植治療近端肱骨骨折的良好替代品。

關鍵字

近端肱骨骨折；脛骨平台結構性異體骨

並列摘要

Introduction: Proximal humerus fracture is a common fracture in the elderly. Although the fracture was treated with open reduction and plate fixation, some loss of reduction with varus angulation still happened. Using fibula allograft as a structural augmentation for treatment of humeral neck fracture was reported to have significant benefit to prevent post-operative an-gulation deformity. However, resources of fibula allograft were limited. Tibia plateau allograft from knee replacement procedure is more accessible for structural augmentation. Methods: From 2011 and 2014, 85 patients with displaced proximal humerus fracture treated with open reduction and plate fixation were randomized to structural allograft augmentation or not. Tibia plateau structural allograft harvested during knee replacement procedure was reinforced in the humeral canal of the fracture site. Post-operative X-rays were taken for comparison. Result: The average of the head-shaft angle (HSA) loss was 9.25 degrees at one month in group I, while in group II, the average of HSA loss was 15.4 degrees. According to statistic analysis, there is a significant difference between two groups (P value ＜ 0.05). Conclusion: Tibia plateau strut allograft from knee replacement procedure could be a good substitute for fibula allograft in treating proximal humerus fracture to decreasing varus deformity.

並列關鍵字

Proximal humerus fracture ； (Strut tibia plateau allograft

國際替代計量

以脛骨平台結構性異體骨與鋼板固定治療近端肱骨骨折

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