老年肱骨近端骨质疏松性复杂骨折治疗的内固定选择

Clinical internal fixation strategy for treatment of senile osteoporotic complicated fracture of proximal humerus

目的:通过对比分析老年肱骨近端骨质疏松性复杂骨折2类不同内固定的疗效,阐述骨折治疗方法的选择。方法:对125例Neer分型三部分和四部分老年肱骨近端骨质疏松性复杂骨折分别采用传统固定(三叶钢板和交叉克氏针)和锁定加压钢板治疗。传统的三叶钢板或交叉克氏针内固定治疗组为A组,锁定加压钢板内固定治疗组为B组,三、四部分骨折分别为亚组。按Neer分型三部分骨折共71例,应用传统固定方法治疗42例(A1组),应用锁定加压钢板治疗29例(B1组);四部分骨折54例,应用传统固定方法治疗19例(A2组),应用锁定加压钢板治疗35例(B2组)。随访时间6～24个月,平均12.2个月。采用Neer百分制评分表评分,大于等于80分为优良。结果:在三部分骨折中,A1组大于等于80分29例,优良率69.05%,B1组大于等于80分26例,优良率89.66%,两组比较差异有显著性P<0.05;在四部分骨折中,A2大于等于80分8例,优良率42.11%,B2组大于等于80分25例,优良率71.43%,两组比较差异有显著性(P<0.05)。结论:对于老年肱骨近端骨质疏松性复杂骨折的治疗,锁定加压钢板与传统固定相比较具有一定的优势。

Objective To compare the efficacy between two different methods of internal fixation in the treatment of senile osteoporotic complicated fractures of proximal humerus. Methods 125 senile patients with osteoporotic complicated fracture were divided into two groups to receive different internal fixation and surgical treatment （Kirschner needle or traditional internal fixation was Group A,internal fixation of locking compression plate was Group B,and there were two respective subsections）. There were 42 patients with Ⅲ-part fracture according to Neer classification receiving Kirschner needle or traditional internal fixation（Group A1）,29 patients with Ⅲ-part fracture receiving internal fixation of locking compression plate（Group B1）. There were 19 patients with Ⅳ-part fracture receiving Kirschner needle or traditional internal fixation（Group A2）,35 patients with Ⅳ-part fracture receiving internal fixation of locking compression plate（Group B2）.The patients were followed up for 6 to 24 months （average 12.2 months）.Neer score system was used to appraise therapeutic effect,and 80 points was defined as excellent and good. Results There were 29 cases exceeding or equaling to 80 points in Group A1,the excellent and good rate was 69.05%,while the patients in Group B1 were 26 and the excellent and good rate was 89.66% ,there was significant difference between two groups （P0.05）. There were 8 patients exceeding or equaling to 80 points in Group A2,the excellent and good rate was 42.11%,while the patients in Group B2 were 25 and the excellent and good rate was 71.43%,there was significant difference between two groups （P0.05）. Conclusion Compared with traditional fixation,locking compression plate has advantage in treatment of senile osteoporotic complicated fractures of proximal humerus