锁定钢板治疗老年肱骨近端骨折合并肩袖撕裂的疗效分析

Clinical effectiveness of locking plate for treatment of elderly proximal humerus fractures combined with rotator cuff tears

目的：探讨、分析锁定钢板治疗老年肱骨近端骨折合并肩袖撕裂的临床效果。方法回顾性分析2012年1月至2013年3月采用锁定钢板治疗的老年肱骨近端骨折合并肩袖撕裂患者22例，男8例，女14例，年龄61～76岁，平均（66.7±4.3）岁。术中复位骨折块后采用锁定钢板进行固定，同时使用缝线缝合修复撕裂的肩袖组织。分别在术前、末次随访时对患者进行臂、肩、手功能障碍（disabilities of the arm，shoulder and hand，DASH）上肢功能评分，并在末次随访时采用Neer肩关节功能评分标准进行临床疗效的评估。结果22例患者均获得成功随访，随访时间为25～32个月，平均（28.3±1.8）个月。末次随访时，患者平均DASH评分由术前的（132.4±5.7）分改善至（46.4±3.8）分，差异具有统计学意义（t=78.368，P＜0.05）；Neer百分制评分结果，优10例、良9例、可3例、差0例，优良率达86.4%（19/22）。所有患者均未发现术中和术后并发症。结论锁定钢板治疗老年肱骨近端骨折合并肩袖撕裂可获得较满意的临床疗效，具有术后并发症少、肩关节功能效果恢复好等优点。

Objective To explore and analyze the clinical outcome of locking plate in treatment of elderly proximal humerus fractures with rotator cuff tears. Methods A retrospective study was performed in 22 cases of elderly proximal humerus fractures with rotator cuff tears who undergone locking plate from January 2012 to March 2013. There were 8 males and 28 females, The average age was （66.7±4.8） years （range, 61-76 years）. Surgical procedure included locking plate fixation after fracture reduction, and simultaneous rotator cuff tears were repaired through suture. Clinical effectiveness was evaluated by disabilities of the arm, shoulder and hand （DASH） before operation and at the last follow-up. Neer score was used as a indication of the function of shoulder at the last follow-up. Results All the 22 patients received an average of （28.3±1.8） months （range, 25-32 months） of follow-up. In the last follow-up visit, the DASH score decreased to （46.4±3.8） from preoperative （132.4±5.7） with statistical significance （t=78.368, P〈0.05）. According to Neer score, 10 cases were excellent, 9 good, and 3 fair, with the excellent rate of 86.4%（19/22）. No patients had complications. Conclusion Locking plate in treatment of elderly proximal humerus fractures combined with rotator cuff tears can achieve excellent functional outcome with minimal postoperative complications.