BMC Musculoskelet Disord:肱骨头缺血性坏死的治疗--术后结果和建议的分类改进

2022-08-15 医路坦克 MedSci原创

根据Boileau的分类,肱骨近端骨折后的肱骨头缺血性坏死是一种罕见的分类且治疗仍然是一个挑战。本研究对解剖型和逆肩关节置换术治疗FS1型进行了评价,并提出了一个新的亚型。

肱骨近端骨折后肱骨头缺血性坏死是一种罕见的,经常疼痛的情况和治疗仍然是一个挑战。波瓦洛将肱骨近端骨折创伤后后遗症分为四种类型。骨折后遗症(FS) 1型被定义为肱骨头骨坏死或头塌陷。到目前为止,已经发表了几种治疗方案,包括大结节截骨、半关节成形术、解剖全肩关节成形术和反肩关节成形术(RSA)。对于FS 1型患者,解剖性肩关节置换术已显示出良好的中期预后。后来,有报道称内翻畸形愈合和肩袖脂肪浸润患者的结果更糟糕,在这种情况下,Moineau等人建议进行亚分类。在这种情况下,解剖型肩关节成形术(ASA)是不合适的,RSA已被证明是一个可靠的治疗选择。

本研究的目的是报道我们对FS 1型肩关节解剖逆行置换术治疗的结果,并回顾性分析导致术后不良结果的预后因素,以便建立一个临床可靠的亚分类。

根据Boileau的分类,肱骨近端骨折后的肱骨头缺血性坏死,即1型骨折后遗症(FS)是一种罕见的分类,治疗仍然是一个挑战。本研究对解剖型和逆肩关节置换术治疗FS1型进行了评价,并提出了一个新的亚型。

方法:这项单中心、回顾性、对比研究,包括四年内所有连续接受手术治疗的1型肱骨近端FS患者。所有患者按建议的3个不同亚型进行分类。对固定评分(CS)、Quick Dash评分、主观肩值(SSV)、翻修及并发症发生率进行分析。术前摄片检查肩峰-肱骨间隔(AHI)和大结节吸收情况。

根据Boileau将肱骨近端骨折后遗症分为1型(a)。1型a病变(b)表现为肱骨头坏死,不伴有肱骨头颅骨化,可采用解剖半肩关节成形术或全肩关节成形术治疗。type1b病变(c)表示肱骨头坏死,伴有肱骨头颅骨化(即肩峰-肱骨间隔缩小< 7mm),应采用逆行肩关节成形术治疗。型病变(d)显示肱骨头坏死伴大结节吸收,也应采用逆行肩关节成形术治疗

一名49岁男性患者肱骨近端1型骨折后遗症的术前(a, b)和随访图像(c, d),即肱骨头坏死,未采用解剖型无柄半关节成形术治疗肱骨头颅骨化。在24个月后的最后跟踪调查中,恒定分数为77分

一名70岁女性患者肱骨近端1型骨折后遗症的术前(a, b)和随访图像(c, d)。逆行肩关节成形术治疗肱骨头坏死伴肱骨头颅骨化。在28个月后的最后跟踪调查中,稳定得分为56分

75岁女性患者肱骨近端1型骨折后遗症的术前(a, b)和随访图像(c, d)。逆行肩关节成形术治疗肱骨头坏死伴大结节吸收。在20个月后的最后跟踪调查中,恒定分数为72分

结果:27例FS 1型患者中,17例(63%)获得24±10个月的随访,平均年龄(64±11)岁。解剖型7例,逆行肩关节置换术10例。CS由治疗前的16±7分显著提高至61±19分(P<0.0001)。末次随访时Quick Dash评分为(21±21)分,SSV为(73±21)分。术前平均AHI为9±3 mm,其中8例AHI<7 mm。4例大结节完全吸收。并发症和翻修率为19%,植入物存活率为88%。

结论:选择合适的手术方法,可获得较好的近期疗效和较低的并发症发生率。对于骨折后遗症的1型,应推广Boileau分类,并对人工全肩关节置换术或人工全肩关节置换术的一般推荐标准作相应调整。

应特别注意AHI降低和/或大结节吸收,作为肩袖功能障碍的间接征兆。为便于选择合适的假体治疗方法,应采用所建议的分类系统。

文献来源:Schmalzl J,  Graf A,  Kimmeyer M,Treatment of avascular necrosis of the humeral head - Postoperative results and a proposed modification of the classification.BMC Musculoskelet Disord 2022 Apr 27;23(1)

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    2022-12-19 cmsvly
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    2023-04-30 redcrab
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    2022-08-16 millore
  7. [GetPortalCommentsPageByObjectIdResponse(id=2013937, encodeId=0265201393e0e, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Tue Jan 31 03:44:32 CST 2023, time=2023-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1975220, encodeId=93c519e522046, content=<a href='/topic/show?id=f145355379' target=_blank style='color:#2F92EE;'>#BMC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3553, encryptionId=f145355379, topicName=BMC)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Wed Jun 07 13:44:32 CST 2023, time=2023-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784536, encodeId=8c501e8453632, content=<a href='/topic/show?id=a727600194' target=_blank style='color:#2F92EE;'>#Disord#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6001, encryptionId=a727600194, topicName=Disord)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Mon Dec 19 07:44:32 CST 2022, time=2022-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1721878, encodeId=83a51e2187810, content=<a href='/topic/show?id=01811016363e' target=_blank style='color:#2F92EE;'>#骨头#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101636, encryptionId=01811016363e, topicName=骨头)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cd033099978, createdName=redcrab, createdTime=Sun Apr 30 12:44:32 CST 2023, time=2023-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893534, encodeId=943f189353461, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Thu May 18 07:44:32 CST 2023, time=2023-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363042, encodeId=ce761363042a8, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Aug 16 16:44:32 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460653, encodeId=c19514606536f, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Tue Aug 16 16:44:32 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238756, encodeId=45ed1238e56ba, content=学习使人快乐, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=69d58251228, createdName=ms2000000359111509, createdTime=Mon Aug 15 10:30:18 CST 2022, time=2022-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238746, encodeId=14c01238e4644, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon Aug 15 09:58:34 CST 2022, time=2022-08-15, status=1, ipAttribution=)]
    2022-08-16 shalley68
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    2022-08-15 ms2000000359111509

    学习使人快乐

    0

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    2022-08-15 yangchou

    好文章,谢谢分享。

    0