骨水泥加钢板固定治疗老年人肱骨上端骨折

Fixation of fractures of the proximal humerus in elderly patients with the bone cement add plate

[目的]介绍应用骨水泥髓内充填加钢板固定治疗老年人肱骨近端不稳定性骨折的技术要点，并对骨水泥固定的原理进行分析。[方法]2003年3月-2005年3月，共10例，男4例，女6例，平均78岁。3分骨折6例，4分骨折4例。采用三角肌-胸大肌间沟入路，直视下复位，先以骨水泥作髓腔内充填，再用钢板固定。术后3d开始功能锻炼。术后1、3、6、12个月行X线片检查及肩关节功能评估。[结果]按JOA功能标准，优5例，良4例，可1例，优良率90％。X线片结果：7例骨折解剖复位，3例骨折仍有3—5mm移位，全部钢板螺钉固定可靠，无松动。骨折均获得愈合。[结论]骨水泥髓内充填加钢板固定治疗老年人肱骨近端不稳定性骨折的固定效果可靠，可以进行早期功能锻炼，获得满意的功能恢复。

[ Objective] To introduce the technique important points of intramedullary fixation with bone cement add the plate fixation for treated the unstable proximal humeral fractures in elderly patients, and proceed the analysis to the principle of bone cement fix, [ Method] Ten cases of the unstable proximal humeral fractures were treated with open reduction, intramedullary fixation with bone cement first, then fix with the plate. Three days after operation functional trainings were began. The radiographic outcome and shoulder joint functions were observed postoperatively at 1 month, 3 months,6 months and 12 months. [ Result ] The results were excellent in 5 cases, good in 4 cases,fair in 1 case according to the JOA function standard. The rate of excellent and good clinical results was 90%. Radiography showed that the fractures dissects to reply in 7 patients, fractures still had 3 -5 mm moving in 3 cases. All plates were fixed dependable, with no loosening. All fractures had bone fusion. [ Conclusion ] The intramedullary fixation with bone cement add fixation with plate for the unstable proximal humeral fractures in the elderly can proceed the functional training of the earlier period, acquire the satisfactory function instauration.