强化锁定钢板方案治疗老年肱骨近端Neer分型三/四部分骨折的效果

Clinical study of intensive locking plate regimen in the treatment of elderly patients with Neer type three/four-part proximal humeral fractures

目的探讨强化锁定钢板方案治疗老年肱骨近端Neer分型三/四部分骨折的临床疗效及安全性。方法回顾性分析收治老年肱骨近端Neer分型三/四部分骨折患者共206例临床资料,其中采用常规锁定钢板方案治疗137例(对照组),采用强化锁定钢板方案治疗69例(观察组);比较两组术后相关疗效指标、并发症发生率及二次手术率。结果观察组术后疼痛VAS评分、骨折愈合时间、肱骨头高度丢失量及内翻角均显著少于对照组(P<0.05);观察组术后肩关节前屈上举、外展及外旋角度均显著大于对照组(P<0.05);观察组术后ASES评分和Constant-Murly评分均显著高于对照组(P<0.05);同时两组术后并发症和二次手术发生率比较差异无统计学意义(P>0.05)。结论强化锁定钢板方案治疗老年肱骨近端Neer分型三/四部分骨折可有效缓解术后疼痛,加快骨折愈合,提高肩关节功能,改善肱骨支撑效应,且未增加术后并发症和二次手术风险。

Objective To investigate the clinical efficacy and safety of intensive locking plate regimen in the treatment of elderly patients with Neer type three/four-part proximal humeral fractures.Methods Clinical data of 206 elderly patients with three/four-part proximal humeral fractures according to Neer typing were retrospectively chosen from July 2010 to July 2018 in our hospital,and divided into 2 groups,including control group(137 patients)with conventional locking plate and treatment group(69 patients)with intensive locking plate.The postoperative outcome indicators,complication incidence and secondary operation rate of the 2 groups were compared.Results The pain VAS score,fracture healing time,loss amount of humeral head height,and humeral head varus angle of treatment group after operation were significantly less than those of control group(P<0.05).The postoperative shoulder flexion,lifting,abduction and rotation angle of treatment group were significantly more than control group(P<0.05).The ASES score and Constant-Murly score of treatment group after operation were significantly higher than control group(P<0.05).There was no significant difference in the complication incidence after operation or secondary operation rate between the 2 groups(P>0.05).Conclusion Intensive locking plate regimen in the treatment of elderly patients with Neer type three/four-part proximal humeral fractures can efficiently relieve postoperative pain,accelerate fracture healing,improve shoulder joint function and humeral supporting effects,without increasing the risk of complications or secondary operation.