老年性肱骨近端移位骨折的外科治疗

Surgical treatment of complex proximal humeral fracture in the elderly

目的探讨老年人复杂肱骨近端移位骨折的外科治疗方法。方法21例患者年龄大于60岁,骨折属NeerⅢ、Ⅳ型或严重移位的Ⅱ型骨折。其中锁定加压钢板固定9例,T型或解剖型钢板固定7例,人工肱骨头置换5例,术后早期功能锻炼。结果随访时间5～30个月。患肩功能按Neer评估标准,三组优良率分别为88.9%、71.4%和60.0%。结论对于复杂的肱骨近端移位骨折,采用手术治疗配合早期功能锻炼,可获得满意的效果;合并骨质疏松的患者更适宜于选用锁定加压钢板固定。

Objective To study surgical treatment of complex proximal humeral fracture in the elderly. Methods We reviewed twenty-one elderly patients with displaced proximal humeral fracture. Nine of 21 cases were treated with AO locking compression plate and 7 cases were operated on with T-shaped or humeral anatomical plates. Five cases with severely displaced four-part fractures were operated on with primary hemiarthroplasty. Early rehabilitation was started after surgery. 21 cases were followed up for 5 to 30 months. Result According to Neer＇s evaluation,excellent and good rates of shoulder joint function in three groups were 88. 9%, 71.4 % and 60. 0 %, respectively. Conclusion For the elderly with displaced proximal humeral fractures, satisfactory results can be obtained by early operation and postoperative rehabilitation. AO locking compression plate is suitable for treating the complex proximal humeral fracture in the patients with osteoporosis.