断端嵌插辅助肩袖缝合与植骨重建肱骨近端内侧柱治疗老年肱骨近端骨折

Treatment of Proximal Humeral Fractures in Elderly Patients with Broken End Insertion Assisted Rotator Cuff Suture and Reconstruction of Medial Column of Proximal Humeral with Bone Graft

目的:比较断端嵌插辅助肩袖缝合与植骨重建肱骨近端内侧柱治疗老年肱骨近端骨折的疗效。方法:行锁定钢板内固定治疗2、3部骨折伴有内侧柱缺损的老年肱骨近端骨折患者51例,分为嵌插组(n=32,行断端嵌插辅助肩袖缝合重建内侧柱)和植骨组(n=19,行自体髂骨植骨重建内侧柱);比较2组患者手术时间、术中出血量、术中透视时间、骨折愈合时间、术后(6个月和12月时)肩关节(Neer)评分优良率及术后12月并发症。结果:嵌插组患者手术时间、术中出血量、骨折愈合时间低于植骨组患者,术后6月的Neer评分优良率高于植骨组患者,差异有统计学意义(P<0.05);术中透视时间、骨折不愈合、术后12月随访Neer评分优良率和并发症比较,差异无统计学意义(P>0.05);术后12月时,嵌插组有3例出现骨折延迟愈合、肱骨头螺钉拔出征象,其中1例肱骨头内翻、断端成角畸形,植骨组1例出现肱骨头坏死。结论:断端嵌插辅助肩袖缝合重建内侧柱术式治疗老年肱骨近端2、3部骨折伴内侧柱缺损的疗效优于自体髂骨植骨重建内侧柱术式。

Objective： To compare the curative effect of broken end insertion assisted rotator cuff suture and reconstruction of medial column of proximal humeral with bone graft in the treatment of proximal humeral fractures in elderly patients. Methods： 51 elderly patients with proximal humerus 2,3 fracture with medial column defect accepting locking plate internal fixation treatment were divided into insertion group and bone graft group. Operation time,intraoperative blood loss,intraoperative fluoroscopy time,fracture healing time,complications in 12 months after surgery,excellent rate of shoulder joint score（ Neer） in 6 months and 12 months after surgery in the two groups were compared. Results：Operation time,intraoperative blood loss,and fracture healing time in insertion group were lower than those in bone graft group. Excellent rate of Neer score in 6 months after surgery in insertion group were higher than that in bone graft group（ P〈0. 05）. The difference of intraoperative fluoroscopy time,fracture nonunion,excellent rate of Neer score in 12 months after surgery and complications between the two groups were not statistically significant（ P〈0. 05）. In 12 months after surgery,there were 3 cases of delayed union of fracture and 1 cases of humeral head screw pull out in the insertion group,among them,1 cases had humeral head varus and broken end angulation deformity. 1 case had humeralhead necrosis in bone graft group. Conclusion： Broken end insertion assisted rotator cuff suture in the treatment of proximal humerus 2,3 fracture with medial column defect in elderly patients is superior to reconstruction of medial column of proximal humeral with bone graft.