锁定加压钢板小切口入路治疗老年肱骨近端骨折观察

Fixation of Elderly Fracture of Proximal Humerus with Locking Compression Plate by Mini-incision Approach from Lateral Shoulder

目的探讨锁定加压钢板(locking compression plate,LCP)经小切口入路在老年肱骨近端骨折治疗中的临床疗效。方法应用LCP肩外侧小切口微创入路治疗老年肱骨近端骨折患者31例,其中男性13例,女性18例;年龄56岁～72岁,平均年龄62.8岁;骨折按Neer分类:二部分骨折8例,三部分骨折19例,四部分骨折4例。受伤原因:车祸9例,摔伤20例,打击伤2例;全部为闭合性骨折。结果术后随访6～36个月,平均约24个月。骨折愈合时间为2.2～6.4个月,平均3.7个月;无1例发生切口感染,未出现腋神经和旋肱血管损伤;随访末的最终疗效按Neer评分,优18例,良11例,可2例,优良率达93.5%。结论LCP肩外侧小切口入路治疗老年肱骨近端骨折,可减少软组织损伤及骨折断端残留血供的破坏,复位满意、固定坚强。术后可早期功能锻炼,防止关节粘连,是一种安全、微创、有效的治疗方法。

Objective To investigate the clinical efficacy of the fixation of elderly fracture of proximal humerus with locking compression plate（LCP） by mini-incision approach from lateral shoulder.Methods 31 elderly patients suffered from elderly fracture of proximal humerus were treated with locking compression plate（LCP） by mini-incision approach from lateral shoulder,male 13 cases,female 18 cases; aged from 56 to 72,average 62.8 years old; fractures according to Neer classification：type Ⅱ（8 cases）,type Ⅲ （19 cases）,type Ⅳ （4 cases）. Cause of injuries：traffic accident （9 cases）,falling （20 cases）,other injuries（2 cases）.Results The patients were followed up 6 to 36 months,an average of about 24 months. Fracture healing time was 2.2 - 6.4 months,on average 3.7 months; No wound infection occurred. Post-operative functional score （Neer score） revealed：excellent（18 cases）,good （11 cases）,fair （2 cases）,the ratio of excellent（18 cases）,good （11 cases） was 93.5%. Conclusion Fixation of elderly fracture of proximal humerus with locking compression plate（LCP） by minimally invasive approach from lateral shoulder is a safe,reliable and minimally invasive procedure with good reduction and stable fixation. Early post-operative functional exercise may be permitted for preventing shoulder joint adhesion.