| 3D技术辅助下半肩置换治疗老年性肱骨近端粉碎性Neer Ⅳ型骨折 |
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投稿时间：2018-12-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 李建文 |
LI Jian-wen |
上虞中医医院骨科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
lijianwen1414@163.com |
| 杨永博 |
YANG Yong-bo |
上虞中医医院骨科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 万蕾 |
WAN Lei |
上虞中医医院骨科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 叶锋 |
YE Feng |
上虞中医医院骨科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 陈园升 |
CHEN Yuan-sheng |
上虞中医医院骨科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 王晓 |
WANG Xiao |
上虞中医医院骨科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第9期，第810-814页 |
| DOI：10.3969/j.issn.1003-0034.2019.09.007 |
| 基金项目: |
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| 中文摘要:目的：观察比较借助3D打印技术行半肩置换术与切开复位锁定钢板治疗中老年性肱骨近端粉碎性骨折（Neer Ⅳ型）的肩关节功能、并发症、临床效果。方法：2012年3月至2018年4月收治31例中老年肱骨近端粉碎性骨折（Neer Ⅳ型），男4例，女27例；年龄55～94岁，平均71岁；病程1～3年。其中采用切开复位锁定钢板内固定（ORIF组）20例，采用3D打印技术辅助下半肩置换术（HA组）11例。通过CT数据借助Mimics软件，在计算机上模拟骨折重建，测量出骨折端到肱骨头高度，大结节到肱骨头高度，肱骨头后倾角，辅助半肩置换。术后随访，行X线检查，观察两组并发症发生率，并对肩关节功能进行Neer评分。结果：31例患者获得随访，时间1～3年，平均2年。HA组无假体松动、断裂和下沉，人工肱骨头完好，大小结节骨折不愈合1例，Neer评分84.18±3.55；ORIF组肱骨近端骨吸收8例，骨折不愈合1例，内固定松动1例，Neer评分55.91±10.78；两组肩关节功能Neer评分比较，差异有统计学意义（P<0.05）。结论：3D技术辅助半肩置换与切复锁定钢板固定治疗中老年肱骨近端粉碎性骨折（Neer Ⅳ型）并发症少，功能恢复较切复内固定好。 |
| 【关键词】肱骨骨折 肩骨折 关节成形术,置换,肩 打印,三维 骨折固定术,内 |
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| Treatment of comminuted Neer Ⅳ fracture of proximal humerus with lower shoulder replacement assisted by 3D technique |
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ABSTRACT
Objective:To observe and compare the shoulder joint function,complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer Ⅳ) with 3D printing technique.
Methods:From March 2012 to April 2018,31 middle age and elderly patients with comminuted proximal humeral fractures (Neer Ⅳ) were treated,including 4 males and 27 females,aged from 55 to 94 years old with an average age of 71 years,with a course of 1 to 3 years. Among them,20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium,the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head,the height of tubercle to humeral head,the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed,the incidence of complications were observed,and Neer score was used for the shoulder joint function.
Results:Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group,there was no prosthesis loosening,fracture and subsidence,the head of artificial humerus was intact,the fracture of nodules and nodules did not heal in 1 case,Neer score was 84.18±3.55;in ORIF group,there were 8 cases of proximal humerus bone resorption,1 case of fracture nonunion,1 case of internal fixation loosening,Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(P<0.05).
Conclusion:3D-assisted hemiarthroplasty and resection locking plate fixation for the treatment of comminuted proximal humeral fractures (Neer Ⅳ type) have fewer complications and better functional recovery than resection and internal fixation. |
| KEY WORDS Humeral fractures Shoulder fractures Arthroplasty,replacement,shoulder Printing,three-dimensional Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李建文,杨永博,万蕾,叶锋,陈园升,王晓.3D技术辅助下半肩置换治疗老年性肱骨近端粉碎性Neer Ⅳ型骨折[J].中国骨伤,2019,32(9):810~814 |
| 英文格式: | LI Jian-wen,YANG Yong-bo,WAN Lei,YE Feng,CHEN Yuan-sheng,WANG Xiao.Treatment of comminuted Neer Ⅳ fracture of proximal humerus with lower shoulder replacement assisted by 3D technique[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(9):810~814 |
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