自体髂骨植骨联合锁定钢板内固定治疗老年肱骨近端骨折

Autologous iliac bone graft combined with locking plate internal fixation for treatment of proximal humerus fractures

目的 探讨自体髂骨植骨联合锁定钢板内固定治疗老年肱骨近端骨折的疗效。方法 采用自体髂骨植骨联合锁定钢板内固定治疗14例老年肱骨近端骨折患者。记录手术时间、术中出血量、骨折复位情况、骨折愈合时间、并发症发生情况。采用肩关节功能Neer评分评价疗效。结果 患者均获得随访,时间6~12(8.8±2.6)个月。手术时间1.0~2.5(1.5±0.6) h,术中出血量200~300(211.5±17.2)ml。术后X线片显示骨折复位良好,钢板和克氏针固定位置满意,关节在位。13例骨折均骨性愈合,时间4~6(4.2±1.3)个月,未发生神经损伤、内固定失效、肩峰撞击综合征、肱骨头内翻等并发症;1例因肱骨头坏死行非手术治疗。末次随访时采用肩关节功能Neer评分评价疗效:优2例,良9例,可2例,差1例,优良率11/14。结论 自体髂骨植骨联合锁定钢板内固定治疗老年肱骨近端骨折,有利于快速复位骨折、纠正内翻,患者能早期功能锻炼改善肩关节功能,且术后并发症发生率低。

Objective To investigate the efficacy of autologous iliac bone graft combined with locking plate internal fixation in the treatment of proximal humerus fractures.Methods The 14 elderly patients with proximal humeral fractures were treated by internal fixation with autologous iliac bone graft and bone locking plate.Operation time,intraoperative blood loss,fracture reduction,fracture healing and postoperative complications were recorded.Neer score of the shoulder function was used to evaluate efficacy.Results All patients were followed up for 6~12(8.8±2.6)months.The operative time was 1.0~2.5(1.5±0.6)h,the intraoperative blood loss was 200~300(211.5±17.2)ml.The postoperative X-ray film showed that the fracture reduction was good,the position of plate and Kirschner wire were satisfactory,and the joint was at normal position.The 13 cases got bony healing,within 4~6(4.2±1.3)months.There were no complications such as nerve injury,internal fixation failure,acromial impingement syndrome,and varus of the humeral head;and 1 case with necrosis of the humeral head underwent non-operation treatment.At the last follow-up,Neer score of shoulder function:excellent in 2 cases,good 9 cases,fair 2,poor 1,with a excellent-good rate of 11/14.Conclusions The treatment of proximal humerus fractures with autologous iliac bone graft combined with locking plate internal fixation is conducive to fast reduction and correction of varus,so that patients can perform early functional exercises to improve shoulder function,and the incidence of postoperative complications is low.