锁定钢板治疗老年肱骨近端骨折后颈干角的变化

Changes in neck shaft angle: locking plate for proximal humeral fracture in senile patients

目的通过观察应用肱骨近端锁定钢板治疗老年肱骨近端骨折术后颈干角的变化,分析影响治疗效果的因素。方法 2008年1月至2013年1月,我院采用肱骨近端锁定钢板治疗肱骨近端骨折老年患者38例(术后失访6例),32例患者术后、术后3个月及最终随访时均拍前后位片及腋位片并测量颈干角。32例患者平均随访12.5个月。结果术后平均颈干角133.5°(124.5°~143.2°),术后3个月平均颈干角129.3°(119.1°~140.6°),最终平均颈干角127.2°(110.4°~140.0°),按时间效应及有无内侧支撑分组分析颈干角的变化有统计学意义。结论重建肱骨近端内侧支撑,术后前3个月合理进行功能锻炼,改善骨骼质量,是老年患者获得最佳功能恢复的关键。

Objective To analyze factors influencing the therapeutic effect of proximal humeral fracture in senile patients through the observation on the change in neck shaft angle following surgery. Methods Thirty-eight senile patients who underwent surgical treatment for proximal humeral fracture with locking plate in our hospital from January 2008 to January 2013 were included in our study and 6 patients failed to have medical follow-up. All the patients had anteroposterior and axillary lateral radiographs right after surgery and 3 months after surgery and at the final medical follow-up visit. The average medical follow-up time for all the patients was 12. 5months. Results Mean neck shaft angle right after surgery was 133. 5°( 124. 5° ~ 143. 2°),mean neck shaft angle 3 months after surgery was 129. 3°( 119. 1° ~ 140. 6°) and that measured at the final medical follow-up was 127. 2°( 110. 4° ~ 140. 0°). Statistically significance could be noted from the prospective of time effect and presence of internal support( P < 0. 05). Conclusion The reconstruction of proximal humeral internal support,functional exercise in the first 3 months after surgery and improvement of skeletal quality was the key to optimal function recovery of senile patients.