锁定钢板结合植骨重建内侧柱治疗老年肱骨近端骨折53例效果分析

Internal Fixation and Reconstruction of Medial Column with Locking Proximal Humeral Plate and Bone Graft in Treatment of Proximal Humeral Fractures of Elderly People

目的:探讨应用锁定钢板结合植骨重建内侧柱治疗肱骨近端骨折的临床效果。方法:2012年2月-2015年10月,骨折复位后应用肱骨近端锁定系统(proximal humeral internal locking system,PHILOS)内固定结合植骨重建内侧柱治疗53例肱骨近端骨折,术中同时修复撕裂的肩袖及关节囊。根据Neer分型:三部分骨折26例,四部分骨折22例,四部分骨折脱位5例。术后早期功能锻炼,采用Constant评定标准评价疗效。结果:53例均获随访,时间12~28个月,平均(18.0±4.5)个月。52例骨折愈合,另1例出现肱骨头坏死吸收,螺钉穿出关节面造成关节功能障碍。根据Constant评分:优36例,良12,可3例,差2例,优良率为90.6%。结论:锁定钢板治疗肱骨近端骨折疗效满意,内侧支撑螺钉加植骨重建内侧柱使肱骨头内下方获得有效支撑,增加了骨折端稳定性,是手术成功的关键。

Objective： To investigate the effects of the medial column support with locking plates for the treatment of Neer three-part and four-part proximal humerus fractures of elderly people.Method： From February 2012 to October 2015, 53 cases of Neer three-part and four-part proximal humeral fractures patients were treated with the medial column support with locking plates and bone graft.The rotator cuff injury were treated at the same timeAccording to Neer classification there were 26 cases of three-part fractures, 22 cases of four-part and 5 cases of four-part fracture - dislocation.Early rehabilitation and rapid recovery.In final follow-up.Constant score was used for functional evaluation.Result： Postoperatively 53 cases were followed up for 12-28 months, on average were （18 ± 4.5） months.Bone union Was achieved in 52 casesaseptic necrosis of head of humerus occurred in 1 case.According to Constant scoring, the excellent and good result rate was 90.6% .Conclusion： Locking plate is an effective implant for treating proximal humeral fractures.Mechanical support of inferior-medial region in the humeral head to maintain the reduction and less soft tissue striping of the fracture site are important for the success of the surgery.