老年肱骨近端骨折的内固定治疗

Internal fixation for proximal humeral fracture of aged patients

目的总结老年肱骨近端骨折的内固定治疗方法。方法1999年1月～2003年1月,收治老年肱骨近端骨折患者32例,男13例,年龄60～88岁,平均73.2岁;女19例,年龄60～94岁,平均75.5岁。按Neer分类标准对肱骨近端骨折进行分型:二部分骨折22例,其中肱骨外科颈骨折占二部分骨折的68.1%;三部分骨折6例;四部分骨折4例。二部分骨折中有3例、三部分骨折中有1例患者因内科合并症或不接受手术而行三角巾悬吊或石膏固定,其余28例均行手术治疗。8例行闭合复位、经皮克氏针内固定;8例经肩峰外侧、三角肌切口手术,其中5例大结节骨折复位后,直接拧入螺钉固定,1例因大结节撕脱骨块较薄,用张力带固定,2例外科颈骨折行带锁髓内钉内固定;12例经三角肌、胸大肌切口手术,5例行钢板螺钉内固定,7例行张力带固定。结果28例手术患者中25例获得随访,随访时间1～3年,平均1.5年。骨折均愈合,5例行张力带治疗的三、四部分骨折患者骨折愈合时间超过3个月,其中2例发生肱骨头坏死。三、四部分骨折患者术后均出现不同程度的关节僵硬,6例残留继发性肩关节挛缩。术后根据UCLA评分,二部分骨折优良率为81.2%,三、四部分骨折优良率为33.3%。结论老年肱骨近端骨折的治疗需根据患者情况选择治疗方法,虽然四部分骨折内固定术后效果欠佳。

Objective To analyse the treatment results of proximal humerus fracture in over sixty-years-old patients. Methods From January 1999 to January 2003, 32 cases suffered from fractures of the proximal humerus were studied, which involved 13 males (mean age 73.2 years, range 60-88 years), and 19 females (mean age 75.5 years, range 60-94 years). There were 22 cases (65.7%) with two-part fractures, among them, 68.1% was surgical neck fracture. 3 cases with two-part and 1 with three-part fracture were treated conservatively because of either their poor health condition or their refusal to operation. The other 28 patients were operated. According to the Neer classification, through the statistic and analysis for the method and outcome, all the cases were evaluated in term of the American UCLA scale system. Results 25 of the 28 operated patients were available at the final follow-up, the mean period was 1.5 years with a range of 1 to 3 years. All the fractures had united. 5 patients with healing time more than 3 months were those fractures classified as three or four-part, which needed the tension-band fixation. All the patients complained with joint stiffness in different degree, 6 of the patients with three or four-part remained with sustaining shoulder contracture. According to the UCLA, the good-excellent rate was 81.2% in the two-part fractures, and only 33.3% in the three or four-part fractures. Conclusion The treatment methods of proximal humerus fracture in aged patients should be selected according to individual condition. The tension band fixation is a good choice for those who can't accept the joint replacement, though the outcome after the four-part fractures fixation is less satisfactory. Joint contracture and humeral head necrosis may be the common complications among the patients rated as three or four-part fractures. After operation, early and complete rehabilitation are closely related to the treatment results.