解剖锁定钢板结合注射式人工骨植骨治疗老年肱骨近端外展嵌插四部分骨折

Anatomical locking plate combined with injectable artificial bone graft for treatment of impacted valgus four-part proximal humeral fractures in the elderly

目的探讨解剖锁定钢板结合注射式人工骨植骨治疗老年肱骨近端外展嵌插四部分骨折的疗效。方法回顾性分析2014年7月至2018年5月复旦大学附属浦东医院采用解剖锁定钢板结合注射式人工骨植骨治疗的11例老年肱骨近端外展嵌插四部分骨折患者的病例资料,其中男性4例、女性7例;平均年龄72岁。评估术后情况、肩关节功能及术后并发症。结果末次随访时,患者视觉模拟评分平均1.6分;多数患者肩关节功能恢复良好,肩关节活动范围:平均前屈角度166°,平均外展角度166°;平均Constant-Murley评分为86.2分;前臂、肩及手快速残疾调查评分平均18.9分。随访过程中无病例出现肱骨头缺血性坏死、螺钉切出或其他内固定失败。结论注射式人工骨植骨一方面填塞外展嵌插复位后造成的骨缺损,另一方面提高螺钉的把持力,可有效解决近端螺钉切出的问题,解剖锁定钢板结合注射式人工骨植骨是治疗老年肱骨近端外展嵌插四部分骨折的有效选择。

Background Proximal humerus fractures account for 5%of all fractures,and the incidence is about 66/10,000 per year.More than 70%occurs in patients over 60 years,which is the second most common upper limb fracture in the elderly.As the aging population increases,and the accompanying risks of osteoporosis and falls,Palvanen,et al.predict that its incidence will double by 2030.Despite the current variety of treatments,anatomical locking plates and their modifications for proximal humerus have been developed to provide fracture fixation by using multiple locking screws implanted in different directions to maximize the number of screws,multi-angle support and resistance to displacement,which have achieved satisfactory clinical results.However,varus deformity,humeral head necrosis and screw cut-out are common complications.As a special type of four-part fracture,the treatment of impacted valgus proximal humeral fracture has certain particularity.The medial column is usually not comminuted,and the blood supply of medial periosteum is not obviously damaged.Therefore,the risk of varus deformity and humeral head necrosis can be significantly reduced,but the problem of screw cut-out cannot be avoided.Academics pointed out that the risk of proximal screw penetration in the glenohumeral joint is up to 43%for patients over the age of 60 with three-part or four-part proximal humeral fractures.This is associated with decreased bone mineral density and limited screw holding capacity in patients,thus affecting the biomechanical behavior of bone-internal fixation.Objective To investigate the effect of anatomical locking plate combined with injectable artificial bone graft in the treatment of impacted valgus four-part proximal humeral fractures in the elderly.Methods From July 2014 to May 2018,11 cases of elderly patients with impacted valgus fourpart proximal humeral fractures were treated with anatomical locking plate combined with injectable artificial bone graft,and the data was retrospectively analyzed.The study included 4 males and 7 females,and the mean age was 72 years.Postoperative pain,shoulder function and postoperative complications were assessed.Results At the last follow-up,the mean VAS score was 1.6 points.Most patients had good shoulder function recovery.The average range of shoulder anteflexion was 166°,and the average range of.The average range of shoulder abduction was 166°.The average Constant-Murley score was 86.2 points;and the average Quick DASH score was 18.9 points.No cases of avascular necrosis of the humeral head,screwing or other internal fixation failure occurred during follow-up.Conclusions Injectable artificial bone graft on the one hand can fill the bone defect caused by valgus and compression.On the other hand,the enhanced force of the screw in the head can effectively solve the problem of proximal screw cut-out.Anatomical locking plate combined with injectable artificial bone graft is an effective option for treatment of impacted valgus four-part proximal humeral fractures in the elderly.