骨水泥增强钢板螺钉固定老年肱骨近端骨折  

Cement-augmented plate and screw fixation for proximal humeral fractures in the elderly

作　　者：吴峰 刘园林 蔡立雄 邹泽良 彭智浩 WU Feng;LIU Yuan-lin;CAI Li-xiong;ZOU Ze-liang;PENG Zhi-hao(Foshan Hospital of Traditional Chinese Medicine,Guangzhou University of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]广州中医药大学附属佛山中医院,广东佛山528000

出　　处：《中国矫形外科杂志》2021年第10期901-905,共5页Orthopedic Journal of China

摘　　要：[目的]探讨骨水泥增强钢板螺钉固定老年肱骨近端骨折的临床疗效。[方法]回顾分析本院2017年1月~2018年1月,采用切开复位锁定钢板螺钉固定老年肱骨近端骨折患者63例。其中,32例对肱骨近折端螺钉采用骨水泥强化,31例未行骨水泥强化。比较两组患者的围手术期、随访和影像资料。[结果]两组患者均顺利手术,两组患者在术中出血量和住院时间的差异无统计学意义(P>0.05)。随访12个月以上。增强组恢复主动活动和完全负重活动时间显著早于未增强组(P<0.05)。术后3个月,增强组VAS评分显著低于未增强组[(1.91±0.48) vs (2.78±0.42),P<0.05];增强组的Constant-Murley评分均显著高于未增强组,术后3个月为[(69.52±4.22) vs (50.24±6.06),P<0.05],术后12个月为[(82.07±4.10) vs (76.21±4.07),P<0.05]。影像方面,末次随访时两组患者肱骨颈干角均较术后即刻有所丢失。末次随访时,增强组的肱骨颈干角显著大于非增强组(P<0.05)。增强组骨折愈合时间显著早于非增强组(P<0.05);增加组晚期影像不良改变率显著低于未增强组(3.13%vs 22.58%,P<0.05)。[结论]采用骨水泥增强钢板螺钉固定老年肱骨近端骨折,可改进肩关节功能,减少颈干角丢失,加快骨折愈合,减少晚期并发症发生率。[Objective] To explore the clinical outcomes of cement-augmented plate and screw fixation of proximal humeral fractures in the elderly. [Methods] A retrospective study was conducted on 63 elderly patients who underwent open reduction and internal fixation with locking plate for proximal humeral fractures in our hospital from January 2017 to January 2018. Among them, 32 patients had screw on proximal fracture segment augmented with bone cement, while the other 31 patients had conventional plate and screw fixation without bone cement augmentation. The patients in the two groups were compared in the data of the perioperative period, follow-up and radiographs.[Results] The patients in both groups were successfully operated, with no statistical differences in intraoperative blood loss and hospital stay between the two groups(P>0.05). The follow up period lasted for more than 12 months. The augmented group resumed active activities and full weight-bearing activities significantly earlier than the non-augmented group(P<0.05). The former proved significantly superior to the latter in terms of VAS score at 3 months postoperatively [(1.91±0.48) vs(2.78±0.42), P<0.05], Constant-Murley score at 3 months after operation [(69.52±4.22) vs(50.24±6.06), P<0.05], and at 12 months postoperatively [(82.07±4.10) vs(76.21±4.07), P<0.05]. With respect to radiographic evaluation, the humeral neck shaft angle got loss in some extent at the latest follow-up compared with that immediately after the operation in both groups. The augmented group had significantly greater humeral neck shaft angle than the non-augmented group at the last follow-up(P<0.05). In addition, the augmented group achieved fracture healing significantly earlier(P<0.05), and had significantly lower adverse radiographic changes(3.13% vs 22.58%, P<0.05) at the latest follow-up than the non-augmented group. [Conclusion] The cement-augmented plate and screw fixation of proximal humeral fractures in the elderly does improve the recovery of shoulder joint function, redu

关 键 词：老年 骨质疏松症 肱骨近端骨折 锁定钢板 骨水泥增强 

分 类 号：R683.42[医药卫生—骨科学]