老年肱骨近端骨质疏松性骨折的临床治疗策略

Surgical Treatment for senile osteoporotic fracture

目的探讨老年肱骨近端骨质疏松性骨折的治疗方法与疗效。方法本组病例收集自2003年3月—2010年3月,共51例,其中男22例,女29例,年龄55~74岁,平均（63.6±7.4）岁。按Neer分型：二部分骨折21例,单纯三部分骨折18例,三部分合并关节脱位3例,单纯四部分骨折9例。其中2例三部分骨折合并关节脱位及7例四部分骨折采用半肩关节置换术,其余均采用锁定加压钢板内固定治疗。随访时间5~34个月,平均（17.6±6.4）个月。结果患者分别按Neer肩关节功能评分标准评估,未见显著性差异。结论锁定加压钢板内固定术是治疗老年肱骨近端骨质疏松性骨折有效选择之一,半肩关节置换为复杂肩关节损伤提供了一个有效的治疗手段。

Objective To discuss the operative technique and treatment effect of senile osteoporotic fracture of the proximal humerus with locking compression plate.Methods A group of 51 cases with senile osteoporotic fracture of the proximal humerus were treated with LCP or Hemi-arthroplasty.Among 51 patients,there were 22 males and 29 females,aged 55~74 years and a mean age of（63.6±7.4） years.Neer fracture classification and rating system were used to appraise the trauma and therapeutic effect.There were 21 patients had two parts fracture,18 patients had simple three parts fracture,3 patients had three parts fracture combined with shoulder dislocation and 9 patients had four parts fracture.All cases were followed up for 5 to 34 months,average（17.6±6.4）months.Results The clinical results were satisfied according to the Neer,Oxford evaluations and no obvious statistics differences were found between the two groups.Conclusion LCP would be an effective choice in the treatment of complex senile osteoporotic fracture of the proximal humerus,Hemi-arthroplasty is a good choice for Neer 4 complex senile osteoporotic fracture.