老年肱骨近端骨折合并肩袖损伤的手术治疗

Operative treatment for proximal humeral fracture with rotator cuff tear in elderly patients

目的 ：探讨老年肱骨近端骨折合并肩袖损伤的手术疗效。方法 ：自2010年3月至2014年8月,对54例老年肱骨近端骨折患者进行手术治疗,其中男30例,女24例;年龄68~83岁,平均71.5岁。自行跌倒伤30例,车祸伤24例。根据Neer分型,一部分骨折3例,二部分骨折11例,三部分骨折21例,四部分骨折19例。所有患者行常规切复钢板内固定术,其中探查有46例肩袖损伤,行肩袖修复术;8例肩袖未损伤。术后采用Neer肩关节功能评分进行疗效评价。结果：合并肩袖损伤的46例患者获得随访,时间8~21个月,平均11个月。全部骨折获得骨性愈合。术后均未出现切口感染、腋神经损伤、螺钉松动、钢板断裂、肩关节脱位以及肱骨头坏死等并发症。参照Neer肩关节功能评分,总分88.60±5.12,其中优30例,良7例,可7例,差2例。结论：对于老年骨质疏松性肱骨近端骨折合并肩袖损伤的患者,采用钢板结合铆钉Ⅰ期修补肩袖是一种有效的固定方法,为肩关节早期功能锻炼提供了有利条件,可获得良好的临床疗效。

Objective：To explore operative clinical outcomes of proximal humeral fracture with rotator cuff tear in elderly patients. Methods：From March 2010 to August 2014,54 elderly patients with proximal humeral fractures with rotator cuff tear were performed operation,including 30 males and 24 females aged from 68 to 83 years old with an average of 71.5 years old.Thirty patients were caused by falling down,24 cases were caused by traffic accident. According to Neer classification,3 cases were partⅠ,11 cases were partⅡ,21 cases were part Ⅲ and 19 cases were part Ⅳ. All patients were operated with open reduction and plate internal fixation,46 cases suffered from rotator cuff tear and carried out repair of rotator cuff; 8 cases were not suffered from rotator cuff tear. Postoperative Neer evaluation of shoulder＇s function were used to assess clinical results. Results：Forty six patients with rotator cuff tear were followed up from 8 to 21 months with an average of 11 months. All fractures were obtained bone union. No incision infection,axillary nerve injury,loosening screw,plate breakage,shoulder joint dislocation and humeral head osteonecrosis were occurred. According to Neer evaluation of shoulder ＇s function,total score was88.60±5.12,and 30 cases got excellent results,7 cases good,7 cases moderate and 2 cases poor. Conclusion：For osteoporotic proximal humeral fractures with rotator cuff tear in elderly patients,plate with rivet repair at stage Ⅰ is an effective stable method,and provide advantages for earlier exercise of shoulder joint,then receive good clinical effects in further.