肱骨近端内固定锁定系统治疗老年肱骨近端骨折的效果观察

The clinical efficacy of proximal humeral internal locking system in treatment of proximal humeral fracturesin elderly patients

目的 探讨肱骨近端内固定锁定系统（PHILOS）治疗老年肱骨近端骨折的效果。方法 将我院2010年1月~2014年12月收治的89例老年肱骨近端骨折患者按治疗方法的不同分为PHILOS组（45例）和传统组（44）。PHILOS组给予PHILOS治疗。传统组给予传统的钢板内固定术治疗。观察两组患者的手术时间、术中出血量及术后并发症。采用Neer评定标准评价肩关节功能,比较两组患者术后1年的肩关节功能。结果 PHILOS组患者术中出血量为（198.2±26.9）ml,手术时间为（61.5±13.9）min,术后并发症发生率为4.4%;传统组分别为（276.6±25.8）ml、（91.5±14.0）min、20.4%,两组比较差异有统计学意义（均P〈0.05）。术后1年进行随访,PHILOS组患者肩关节功能优24例（53.3%）,良18例（40.0%）,可3例（6.7%）,差0例（0）;传统组分别为12例（27.3%）、15例（34.1%）、可10例（2.7%）、7例（15.9%）。两组患者优良率分别为93.3%、61.4%,两组比较差异有统计学意义（P〈0.05）。结论 PHILOS治疗老年肱骨近端骨折较传统的治疗方法对机体的损伤小,肩关节功能恢复好,值得临床推广应用。

Objective To investigate the clinical effect of proximal humeral internal locking system （PHILOS） in treatment of proximal humeral fractures in elderly patients.Methods 89 cases of elderly patients with proximal humeral fractures who were hospitalized in our hospital from January 2010 to December 2014 were selected as our object.They were divided into the PHILOS group（45 cases） and the control group（44 cases） by treatment methods.The patients in the PHILOS group were treated with PHILOS and the patients in the control group were treated with locking plate fixation. The duration of operation,intraoperative blood loss,postoperative complicationsin between two groups were recorded.The recovery of shoulder joint function were compared between PHILOS group.The recovery of shoulder joint function were evaluated with Neer evaluation criteria and control group 1 year after operation.Results The duration of operation in PHILOS group[（61.5±13.9）min] was shorter than that in control group [（91.5±14.0）min]（P〈0.05）.The intraoperative blood loss in PHILOS group [（198.2±26.9）ml] was less than that in control group [（276.6±25.8）ml]（P〈0.05）.The postoperative complicationsin PHILOS group（4.4%） was lower than that in control group（20.4%）（P〈0.05）.In PHILOS group,best shoulder joint function was in 24 cases（53.3%）,good in 18 cases（40.0%）,general in 3 cases（6.7%）,poor in 0 case.In control group,best shoulder joint function was in 12 cases（27.3%）,good in 15 cases（34.1%）,general in 10 cases（2.7%）,poor in 7 cases（15.9%）.The excellent rates of the two groups were 93.3% and 61.4% respectively the difference was statistically significant （P〈0.05）.Conclusion PHILOS has the advantages of less damage and good recovery of shoulder joint function with locking plate fixation in treatment of proximal humeral fractures in elderly patients.This treatment is worth clinical promotion.