锁定钢板治疗老年肱骨近端骨折的疗效

Effect of locking plate fixation for proximal humeral fractures in elderly patients

目的探讨采用锁定钢板内固定治疗老年肱骨近端骨折的临床效果。方法采用回顾性病例对照研究分析2013年10月-2015年10月收治的96例老年移位的闭合性肱骨近端骨折患者临床资料，其中男52例，女44例；年龄62—74岁[（68．2±1．4）岁]。骨折根据Neer分型：两部分骨折27例，三部分骨折57例，四部分骨折12例。按手术方式不同分为肱骨近端锁定钢板内固定组（观察组）和解剖钢板内固定组（对照组），每组48例。观察两组手术时间、术中出血量、住院时间、骨折愈合时间、肱骨头内翻角度、视觉模拟评分（VAS）、肩关节恢复情况（Neer肩关节功能评分）及术后并发症情况。结果患者均获随访13—24个月，平均18．5个月。对照组手术时间为（73．2±27．3）min，术中出血量为（270．9±34．8）m1，住院时间为（13．1±2．2）d、骨折愈合时间为（122．9±18．9）d，肱骨头内翻角度为（4．2±1．3）°，VAS为（5．1±1．2）分；观察组分别为（51．2±14．8）min、（158．3±32．9）ml、（8．2±2．9）d、（93．7±18．4）d、（2．2±1．8）°、（2．0±0．7）分，均明显低于对照组（P均〈0．05）。肩关节功能恢复的优良率（98％）较对照组（90％）明显提高（P〈0．05）。术后并发症发生率观察组（10％）较对照组（21％）明显降低（P〈0．05）。结论锁定钢板内固定治疗老年肱骨近端骨折较解剖钢板能明显缩短手术时间，减少术中出血量，促进骨折愈合，提高患者肩关节功能活动，减少术后并发症的发生，临床疗效满意。

Objective To investigate the clinical effect of locking plate fixation in treatment of proximal humeral fractures in the elderly. Methods This retrospective ease control study enrolled 96 patients with closed proximal humeral fractures admitted from October 2013 and October 2015. There were 52 males and 44 females, with age of （68.2 -1.4）years （range, 62-74 years）. According to the Neer classification of proximal humeral fractures, two-part fractures were noted in 27 patients, three-part fractures in 57, and four-part fractures in 12. According to the surgical methods, the patients were assigned to locking plate fixation （ observation group） and anatomic plate fixation （ control group） , with 48 cases each. Operation time, intraoperative blood loss, hospitalization time, fracture healing time, varus angle of the humeral head, visual analogue score （VAS） , Neer shoulder score for shoulder function and related complications were observed. Results All patients were followed up for 13-24 months （mean, 18.5 months）, Better results were observed in observation group than control group in aspects of operation time [ （51.2 ± 14.8 ） minutes vs. （73.2 ± 27.3） minutes ], intraoperative bleeding [ （ 158.3± 32.9） ml vs. （270.9 ±34.8）ml], hospitalization time [ （8.2±2.9）days vs. （13.1±2.2）days], fracture healing time [（93.7±18.4）daysvs. （122.9±18.9）days], varus angle of the humeral head [（2.2±1.8）° vs. （4.2±1.3） °, VAS [ （2.0 ± 0.7） points vs. （5.1 ± 1.2） points ], excellence rate of Neer score （98% vs. 90% ） and postoperative complication incidence （ 10% vs. 21% ） （P 〈 0. 05 ）. Conclusion Compared with the anatomical plate, locking plate fixation has advantages of shorter operation time, less intraoperative bleeding, earlier bone healing, better shoulder movement and less postoperative complications in treatment of proximal humeral fractures.