老年肱骨近端骨折的治疗进展

Advances in the Treatment of Proximal Hu-meral Fractures in the Elderly

肱骨近端骨折是临床常见的老年骨质疏松性骨折,多数无明显移位的肱骨近端骨折的老年患者接受保守治疗效果良好。采用非手术方式治疗移位的肱骨近端骨折效果较差,常因畸形愈合而导致患者肩部疼痛和活动受限,严重削弱其生活自理能力,需行手术治疗。但是采用切开复位内固定治疗老年肱骨近端骨折仍面临以下困境:由于骨质疏松,骨折常合并压缩性骨缺损,解剖复位粉碎性骨折难以实现;常见内固定器械无法维持骨质疏松性骨折复位至愈合。目前对于移位的老年肱骨近端骨折选择何种内固定治疗方式仍然缺乏共识。笔者通过复习新的指南及文献,论述老年肱骨近端骨折适宜的治疗策略。

Proximal humeral fracture is a common osteoporotic fracture in the elderly. Most elderly patients without significant displaced proximal humeral fractures receive good results with conservative treatment. Non-operative treatment of displaced proximal humeral fractures is less effective and often results in shoulder pain and limited mobility due to deformity healing, which severely impairs the patient’s ability to care for himself and requires surgical treatment. However, the treatment of displaced proximal humeral fractures by incisional internal fixation still faces the following dilem-mas: due to osteoporosis, fractures are often combined with compression bone defects, and ana-tomical reduction of comminuted fractures is difficult to achieve;common internal fixation devices are unable to maintain osteoporotic fractures until they heal. There is still a lack of consensus on the choice of internal fixation treatment for displaced proximal humeral fractures in the elderly. By reviewing new guidelines and literature, the author discusses the appropriate treatment strategy for proximal humeral fractures in the elderly.