单轴和多轴锁定内固定治疗老年肱骨近端骨折  

Comparison of the Effects of Uniaxial and Polyaxial Locking Osteosynthesis System for Proximal Humeral Fractures in Elderly Patients

作　　者：施鸿飞[1] 熊进[1] 陈一心[1] 王骏飞[1] 王守丰[1] 陈志军[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,江苏南京210008

出　　处：《实用骨科杂志》2010年第9期641-644,共4页Journal of Practical Orthopaedics

摘　　要：目的分析并比较单轴和多轴锁定内固定系统在老年肱骨近端骨折治疗中的效果。方法回顾2007年4月至2008年9月收治的老年肱骨近端骨折42例,平均年龄66岁。根据Neer分型,二部分骨折12例,三部分骨折23例,四部分骨折7例。均行手术治疗,采用单轴或多轴锁定内固定系统固定,术后行阶段性功能锻炼。结果两组手术时间无显著差异,操作难度相似。本组随访12～18个月,平均13个月。术后骨折均愈合良好,无内固定失败,仅1例发生肱骨头部分坏死。术后12个月对肩关节行Constant-Murley评分,单轴组二部分骨折的优良率为85.7%,三部分骨折为80%,四部分骨折为60%。多轴组二部分骨折的优良率为87.5%,三部分骨折为83.3%。结论单轴与多轴治疗老年肱骨近端骨折均可获得较为满意的临床疗效。良好的复位、坚强的固定和早期功能锻炼是治疗的关键。Objective To compare the clinical outcomes of proximal humeral fractures in elderly patients managed with uniaxial or polyaxial locking osteosynthesis system.Methods Totally 42 cases of proximal humeral fracture were reviewed from April 2007 to September 2008,including 12 cases of two-part（Neer classification）,23 cases of three-part,and 7 cases of four-part fractures.All the patients received open reduction and internal fixation with PHILOS or Numelock system.Strategic rehabilitation was conducted during the follow-up.Results No significant difference was observed concerning the surgical time or difficulty between PHILOS and Numelock groups.All the fractures healed successfully without implant failure.Only one case showed partial avascular necrosis of femoral head.After 12 months of follow-up,PHILOS group achieved 85.7% of excellent or good function outcome（Constant-Murley score） in two-part fractures,80% in three-part fractures,and 60% in fourpart fractures.Numelock group achieved 87.5% of excellent or good function outcome in two-part and 83.3% in three-part fractures.Conclusion Both PHILOS and Numelock system led to satisfactory clinical outcomes following excellent reduction,rigid fixation and early rehabilitation.

关 键 词：肱骨近端骨折 锁定钢板 老年 骨质疏松 

分 类 号：R683.41[医药卫生—骨科学]