有限骨水泥锁定钉板固定治疗老年肱骨近端骨折疗效观察

Clinical Observation of Limited Cement Locking Nail Plate Fixation in Treatment of Elderly Proximal Humeral Fractures

目的探讨有限骨水泥锁定钉板固定治疗老年肱骨近端骨折术后骨折端愈合及肩关节功能的临床效果。方法32例老年肱骨近端骨折患者,均采用有限骨水泥锁定螺钉钢板内固定治疗,术后随访评价患者肩关节功能恢复情况、骨折端愈合及骨折端固定移位情况等。结果经12~18个月随访,至末次随访时,所有骨折均愈合,优良率达89%。其中2例肱骨头复位部分丢失、轻度内翻,与肱骨内侧支撑欠佳有关。患者术后疼痛减轻,VAS评分平均6分,在后期康复过程中随时间推移疼痛评分持续下降,术后3月内VAS评分维持在3分,功能锻炼时VAS评分为4分。术后6月后大部分患者能够维持无痛活动,优良率达92%。22例伤肩活动完全正常,7例活动轻度受限,3例明显受限;29例恢复伤前运动和劳动能力,3例未达至伤前运动劳动水准,优良率91%。结论有限骨水泥锁定钉板固定治疗老年肱骨近端骨折可改进肩关节功能,有效预防肱骨头内翻塌陷,预防内固定失效,促进骨折愈合,减少肩关节致残发生率。

Objective To investigate the clinical effect of limited cement locking nail plate fixation in the treatment of postoperative fracture healing and shoulder joint function in elderly proximal humeral fractures.Methods A total of 32 elderly patients with proximal humeral fractures were treated with limited cement locking screw plate internal fixation,and the functional recovery of shoulder joint,fracture healing and fracture fixation displacement were evaluated during postoperative follow-up.Results After 12 to 18 months of follow-up,all fractures healed by the last follow-up.The excellent and good rate reached 89%.Two of them showed partial loss of humeral head reduction and mild varus were associated with poor medial humeral support.Postoperative pain was relieved.The average VAS score was 6.The pain score continued to decline over time during the later rehabilitation process,and the VAS score remained at 3 within 3 months after surgery,while the VAS score was 4 during functional exercise.Most patients were able to maintain painless activities 6 months after surgery.Excellent and good rate reached 92%.22 cases of shoulder injury were completely normal,7 cases slightly limited,and 3 cases significantly limited;29 cases recovered their ability to exercise and work before injury,and 3 cases did not reach the level of exercise and work before injury.Excellent and good rate was 91%.Conclusion Fixation with finite cement locking nail plate in the treatment of elderly proximal humeral fractures can improve the function of shoulder joint,effectively prevent the collapse of humeral head varus,prevent internal fixation failure,promote fracture healing,and reduce the incidence rate of shoulder joint disability.