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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2019, Vol. 07 ›› Issue (01) : 78 -82. doi: 10.3877/cma.j.issn.2095-5790.2019.01.012

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肱骨近端骨折钢板内固定术后肱骨头坏死的研究进展
盛宁1, 汪秋柯1, 陈云丰1,†()   
  1. 1. 200233　上海交通大学附属第六人民医院骨科
  • 收稿日期:2018-06-14 出版日期:2019-02-05
  • 通信作者: 陈云丰
  • 基金资助:
    促进市级医院临床技能与临床创新能力三年行动计划项目(16CR3042A)

Study review of humeral head osteonecrosis after plate fixation of proximal humeral fractures

Ning Sheng1, Qiuke Wang1, Yunfeng Chen1()   

  • Received:2018-06-14 Published:2019-02-05
  • Corresponding author: Yunfeng Chen
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盛宁, 汪秋柯, 陈云丰. 肱骨近端骨折钢板内固定术后肱骨头坏死的研究进展[J]. 中华肩肘外科电子杂志, 2019, 07(01): 78-82.

Ning Sheng, Qiuke Wang, Yunfeng Chen. Study review of humeral head osteonecrosis after plate fixation of proximal humeral fractures[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2019, 07(01): 78-82.

表1 肱骨头坏死分期表
分期 特异性表现
I期 X线表现正常；MRI中在T1相上原本正常的骨髓脂肪高信号区被低信号代替，T2相上可以出现高信号，但并不能区分异常信号是创伤性水肿引起还是早期的骨坏死
II期 缺血性坏死出现修复的过程，可能出现硬化区（包括楔状、广泛斑片状）或者骨密度降低表现，两者可同时出现；此时肱骨头的球形曲面仍保持完整
III期 肱骨头出现特征性的新月形，是因为沉积于死骨之上的新骨形成硬化带，再由机械负荷使软骨下骨连接处产生微骨折和塌陷，最终形成的一个可透射区域；在这期，可以出现关节面小凹陷
IV期 由于下面的骨小梁破坏，软骨下骨坏死，导致关节面出现广泛塌陷，可能伴随骨软骨增生
V期 因为关节不匹配出现继发性的关节退变
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