锁定钢板联合人工骨植入治疗老年肱骨近端粉碎性骨折

Treatment of 21 cases of comminuted proximal humeral fractures with fixation of locking plates and artificial bone implantation in senile patients

目的评估锁定钢板联合人工骨植入治疗老年肱骨近端粉碎性骨折的临床疗效。方法对2007年6月至2011年9月经手术治疗的21例肱骨老年近端粉碎性骨折患者进行回顾性分析。按Neer分型三部分骨折14例,四部分骨折7例。均采用沙滩椅位,经肩关节前入路、肱骨近端锁定钢板联合人工骨植入手术方式。结果 21例均获得随访,随访时间为5～30个月,平均16个月。根据肩关节Constant评价标准,平均为81.2分(64～93分),优13例,良6例,可2例,优良率90.5%。结论锁定钢板联合人工骨植入是治疗老年肱骨近端粉碎性骨折的可靠方法,能提供坚强的固定,允许术后早期功能锻炼。

Objective To evaluate clinical effects of locking plates combined with artificial bone implantation on comminuted proximal humeral fractures in senile patients. Methods A retrospective analysis was made in 21 patients with the comminuted proximal humeral fractures, who underwent surgical treatment from June 2007 to September 2009 in our hospital. According to the Neer classifi- cation, 14 patients had three-part fractures and 7 patients had four-part fractures. All patients were treated with the anterior approach by fixation of locking proximal humeral plates and artificial bone implantation in the beach chair position. Results All the patients had medical follow-ups for durations of 5 to 30 months, with an average of 16 months. According to the Constant evaluation criteria, average scores were 81.2 （with scores of 64 to 93 ）. Of the 21 cases, 13 were of excellent recovery, 6 were of good recovery, 2 were of tolera- bly good recovery, but without any case of poor recovery. On the whole, total good recovery rate was as high as 90.5%. Conclusion Internal fixation of locking plates combined with artificial bone implantation was a reliable method for the treatment of comminuted proxi-mal humeral fractures in senile patients. This treatment regimen could provide firm internal fixation on the one hand, and enable pa- tients to have early functional exercise after surgery on the other.