老年肱骨近端骨折骨水泥加钢板治疗

Treatment of proximal humeral fractures in elderly patients with cloverleaf plate supplemented with bone cement

目的讨论骨水泥填塞加钢板内固定术治疗老年肱骨近端粉碎性骨折的疗效。方法2000年1月～2001年6月收治的13例老年肱骨近端粉碎性骨折患者,X线片上表现为有移位短缩,经肩关节前入路进入复位后,对仍有明显骨质缺失的部位,填入骨水泥,替补缺损骨皮质后,行三叶草状钢板螺丝钉内固定。术后吊带悬吊,3周后功能锻炼。结果13例均获随访,平均8.3个月。肩关节可外展超过90°,能提物,X线片均无肱骨头坏死,骨折对位对线好,按Neer功能评分标准,优10例,良3例。结论对于老年骨质疏松,骨质缺损严重,单纯内固定不易者,可以行骨水泥填塞加钢板内固定技术,方便可靠,避免人工关节置换。

Objective To study the efficacy of treatment of proximal humeral fractures in elderly patients using cloverleaf plate combined with bone cement. Methods 13 aged patients with serious proximal humeral fractures were admitted from 2000.1 to 2001.6. Their X ray revealed displacement and crispation. After anterior reduction through the shoulder joint, the obvious osseous defects were filled with bone cement. Then the fractures were fixed with cloverleaf plates. Sling was applied for the patients postoperatively and the rehabilitation program started 3 weeks after operation. Results All the 13 cases were followed up. The follow up ranged from 5 to 10 months with an average of 8.3 months. The range of motion was satisfactory with a mean abduction over 90 degrees. X ray revealedthat no patient demonstrated osteonecrosis of the humeral head. Union was achieved in all the patients. According to Neers scale, the function of shouder was excellent in 10 cases, and good in 3 cases. Conclusion This methods is recommended for aged patients with osteoporosis, serious osseous defects and difficulty of using internal fixation alone, because it is convenient and reliable and can prevent replacement of joint prosthesis.