微创锁定钢板内固定术治疗老年肱骨近端骨折疗效及随访结果分析

Clinical efficacy and follow-up analysis of minimally invasive locking plate fixation for the treatment of proximal humeral fractures in elderly patients

目的探讨微创锁定钢板内固定术治疗老年肱骨近端骨折的临床疗效及其预后。方法选择2006年1月至2009年10月于崇州市人民医院骨科诊治的56例老年肱骨近端骨折患者,随机分为微创锁定钢板内固定术治疗组(微创组)和闭合复位经皮穿针内固定术治疗组(闭合组),每组各28例,比较两组患者术中出血量、手术时间、负重锻炼时间、住院时间、并发症发生情况、视觉模拟评分(VAS评分)、Neer评分、Mayo评分以及随访X线摄片检查结果。结果术后两组患者VAS评分均较术前明显下降(P<0.05),且术后第1、7天微创组VAS评分均明显小于闭合组(P<0.05)。微创组术中出血量、手术时间、可负重时间、骨性愈合时间、继发感染发生率和固定失败率均明显低于闭合组(P<0.05)。微创组Neer评分和Mayo评分优良率分别为85.71%和96.42%,均明显高于闭合组(P<0.05)。结论与闭合复位经皮穿针内固定术相比,微创锁定钢板内固定术治疗肱骨近端骨折可获得较满意的临床疗效,以及更好的关节功能恢复和预后。

Objective To explore the clinical efficacy and follow-up results of minimally invasive locking plate fixation for the treatment of proximal humeral fractures in elderly patients .Methods A total of 56 elderly cases of proximal humeral fractures ,treated in Department of Orthopedics ,Peoples′Hospital of Chongzhou City between Jan-uary 2006 and October 2009 ,were enrolled and randomly divided into minimally invasive locking plate fixation group （minimally invasive group） and closed reduction and percutaneous pin fixation group （traditional group） ,and with 28 cases in each group .Blood loss ,operative time ,weight-bearing exercise time ,hospitalization time ,complications , visual analogue scales （VAS） score ,Neer score ,Mayo score and X-ray examination results during follow-up of the two groups were compared .Results After surgery ,VAS scores of the both groups were significantly decreased （P〈0 .05） ,and VAS scores at postoperative 1 and 7 days in minimally invasive group were significantly less than traditional group （P〈0 .05） .Intraoperative blood loss ,operation time ,weight-bearing exercise time ,time for bone healing ,incidence rate of secondary infection and rate of implant failure in minimally invasive group were significantly lower than traditional group （P〈0 .05） .Excellent rates of Neer and Mayo scores in minimally invasive group were 85 .71% and 96 .42% ,which were significantly higher than traditional group （P〈0 .05） .Conclusion Compared with closed reduction and percutaneous pin fixation ,minimally invasive locking plate fixation for the treatment of proximal humeral fractures could obtain satisfactory clinical efficacy and better joint function recovery and prognosis .