肱骨近端解剖锁定钢板与解剖钢板治疗肱骨Neer三、四部分骨折的疗效比较

Comparison of proximal humerus locking plate and anatomical plate for Neer three-and four-part of proximal humeral fractures

目的探讨肱骨近端解剖钢板与肱骨近端解剖锁定钢板治疗老年肱骨近端Neer三、四部分骨折的功能及疗效差异。方法收集有完整随访资料的151例老年Neer三、四部分骨折患者,按手术方式分为肱骨近端解剖钢板组(A组,65例)和肱骨近端解剖锁定钢板组(B组,86例),在随访过程采用Constant评分及Neer评分评价并比较两组疗效。结果 B组平均愈合时间显著短于A组(P<0.05)。两组的术后1年和术后2年功能比较:B组Neer评分的疼痛、功能、活动度及总分均显著优于A组(P<0.05);B组Constant评分的疼痛、日常生活活动、主动活动及总分显著优于A组(P<0.05)。结论肱骨近端解剖钢板与肱骨近端解剖锁定钢板均可用于老年Neer三、四部分骨折,但解剖锁定钢板愈合更快,功能恢复更好,临床推荐优先使用。

Objective To investigate the effect of proximal humerus locking plate and proximal humerus anatomical plate on complex 3- and 4-part fractures of the proximal humerus（Neer classification） in the elders. Methods 151 cases of proximal humeral fractures were included in the study and divided into proximal humerus anatomical plate group（A group, n=65 cases） and proximal humerus locking plate group（B group, n=86 cases） according to different operation methods. The patients of A group underwent fracture fixation by anatomical plate and those in B group received fracture fixation by locking proximal humerus plate. The treatment effect was evaluated in two groups and compared between two groups by Neer score and Constant score. Results The mean humerus healing time of B group was significant superior to A group（P0.05）. Neer score, constant score,pain, function, activity and total score of shoulder in B group were significant superior to those in A group in 1 year and 2 years after operation（P0.05）. Conclusion Proximal humerus locking plate and proximal humerus anatomical plate could be used for three-and four-part of proximal humeral fractures in the elders, but proximal humerus locking plate has andvantage for humerus healing time,functional rehabilitation.