自体骨髓间充质细胞联合锁定钢板治疗老年肱骨近端骨折

Autologous bone marrow mesenchymal cells combined with locking plates for the treatment of elderly proximal humeral fractures

目的探讨自体骨髓间充质细胞联合锁定钢板治疗老年肱骨近端骨折的疗效。方法采用自体骨髓间充质细胞联合锁定钢板治疗30例老年肱骨近端骨折患者。记录手术情况、骨折愈合情况、并发症发生情况、疼痛VAS评分、肩关节活动度,采用Constant-Murley评分评价肩关节功能。结果手术时间90~120 min,术中出血量150~250 ml。患者均获得随访,时间12~34个月。骨痂形成时间4~12周,骨折愈合时间12~24周。未发生内固定失效、肱骨头下沉及内翻、肱骨头缺血性坏死等并发症。末次随访时,肩关节疼痛VAS评分1~4分;肩关节活动度:前屈上举110°~155°,外展105°~150°,外旋15°~45°,后伸30°~50°;采用Constant-Murley评分评价肩关节功能:总分78~95分,其中优22例,良5例,可3例,优良率27/30。结论自体骨髓间充质细胞联合锁定钢板治疗老年肱骨近端骨折并发症少,关节功能恢复较好,疗效可靠。

Objective To investigate the efficacy of autologous bone marrow mesenchymal cells combined with locking plates in the treatment of elderly proximal humeral fractures.Methods The 30 elderly patients with proximal humerus fractures were treated with autologous bone marrow mesenchymal cells combined with locking plates.Surgical conditions,fracture healing conditions,complications,pain VAS and shoulder activity were recorded.Constant-Murley score was used to evaluate shoulder function.Results The operative time was 90~120 min,intraoperative blood loss was 150~250 ml.All 30 cases were followed up for 12~34 months.Callus formation time was 4~12 weeks.Fracture healing time was 12~24 weeks.There were no failure of internal fixation,subsidence and varus of the humeral head,and avascular necrosis of the humerus head.At the last follow-up,shoulder motion:anteflexion and upward lifting was 110°~155°,abduction was 105°~150°,external rotation was 15°~45°,and posterior extension was 30°~50°.At the last follow-up,Constant-Murley score of shoulder function:total scores were 78~95 points,the results were excellent in 21 cases,good in 5 cases,and fair in 3 cases,with an excellent-good rate of 27/30.Conclusions Autologous bone marrow mesenchymal cells combined with locking plates for treatment of elderly proximal humeral fractures has fewer complications,better joint function recovery and reliable efficacy.