肱骨近端锁定板治疗老年复杂肱骨近端骨折的疗效分析  

Effect Analysis of the Treatment on Comminuted Fracture of Proximal Humerus in Elderly Patients

作　　者：费凯[1] 韩伟峰[1] 王冰[1] 王浩[1] Fei Kai;Han Weifeng;Wang Bing(Department of Orthopaedics,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院骨科

出　　处：《实用骨科杂志》2019年第10期875-878,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨老年复杂肱骨近端骨折的手术治疗及疗效。方法回顾性分析我院2010年3月至2016年3月应用解剖锁定钢板治疗NeerⅢ型和Ⅳ型老年复杂肱骨近端骨折的患者,58例获得完整随访,其中男26例,女32例;年龄60~85岁,平均(68.5±2.5)岁。左侧30例,右侧28例。NeerⅢ型骨折48例,Ⅳ型骨折10例;合并肩关节脱位8例,颅脑损伤15例。58例患者均行肱骨近端解剖锁定钢板切开复位内固定手术,术后功能采用Constant-Murley绝对值评分法进行临床疗效评价,术后行X线片定期复查骨折愈合情况。结果随访时间为24~60个月,平均为(39.0±8.6)个月。Constant-Murley评分为56~95分,平均为(82.6±2.3)分;优34.5%(20/58),良51.7%(30/58),可10.34%(6/58),差3.45%(2/58)。随访期内无一例肱骨头坏死病例,术后6~8周骨折均达到临床愈合标准。结论肱骨近端粉碎性骨折合并肩关节脱位的患者,早期行手法复位条件允许后尽早行骨折手术内固定。术后早期行肩关节功能锻炼和抗骨质疏松治疗,不仅能获得较好的肩关节功能,而且有利于骨折良好愈合,临床疗效较为满意。Objective To investigate the clinical efficacy of surgical treatment of comminuted proximal humeral fractures.Methods Retrospective analysis of 58 cases of proximal humerus comminuted fractures treated with anatomical locking plate internal fixation between March 2010 and March 2016 in our hospital and complete follow-up was obtained.This study included 26 cases of male and 32 cases of female.The patients aged 60 to 85 years,with an average age of(68.5±2.5)years.According to Neer classification,there were 48 cases of 3-part fracture,10 cases of 4-part fracture,8 cases of proximal humerus comminuted fracture with shoulder dislocation,and 15 cases of craniocerebral injury combined with proximal humerus comminuted fracture.All of them were treated with proximal humerus anatomical locking plate for open reduction and internal fixation,postoperative external fixation,and guided early passive functional exercise.Clinical efficacy was evaluated by Neer shoulder function score,pain visual simulation score and Constant shoulder score.Reexamination of fracture healing by X-ray plain film.Results Follow-up time ranged from 24 to 60 months,with an average of(39±8.6)months.During the follow-up period,there were no case of humerus head necrosis.According to the Neer shoulder function score,there were excellent in 20 cases(34.5%),good in 30 cases(51.7%),medium in 6 cases(10.34%)and poor in 2 cases(3.45%).The 1 year follow-up after X-ray operation was up to the standard of clinical healing.Conclusion Early internal fixation for comminuted fractures of the proximal humerus and early operative internal fixation for fractures may be performed in patients with shoulder dislocation.Early functional exercise of shoulder joint was performed under the protection of postoperative abduction stent.It can not only obtain better shoulder joint function,but also be beneficial to the good healing of fracture,which can obtain more satisfactory clinical curative effect.

关 键 词：肱骨近端骨折 老年人 内固定 治疗结果 

分 类 号：R683.41[医药卫生—骨科学]