【摘要】 [目的]探讨内侧柱支撑重建结合锁定钢板内固定治疗老年肱骨近端骨折的临床疗效。[方法]回顾性分析2011年8月~2013年9月本科治疗的62例老年肱骨近端骨折病人的临床资料,男28例,女34例。年龄61~75岁。骨折类型采用Neer分型:2部分骨折13例,3部分骨折29例,4部分骨折20例。均采用肱骨近端锁定接骨板(LPHP)内固定,术中注意恢复肱骨近端内侧柱的有效支撑重建,术后第1、3、6、9、12个月定期门诊随访并摄X线片,通过测量骨折愈合后肱骨头的内翻角度、肩关节功能Constant评分、视觉模拟疼痛评分(VAS)及相关手术并发症等指标综合判断疗效。[结果]所有患者末次随访时骨折均骨性愈合,肩关节功能Constant评分优良率为79%,平均分82分;视觉模拟疼痛评分为(2.8±2.2)分,术后肱骨头内翻角度平均为(4.5°±3.1°),且肱骨头内翻角度≥10°的患者4例(6.4%)。术后共8例患者发生相关并发症(12.9%),分别为脂肪液化、螺钉松动、肩关节僵硬、螺钉穿入盂肱关节间隙和肱骨头无菌性坏死各1例(各占1.6%),肩峰撞击2例(3.2%),1例患者同时合并肩峰撞击与螺钉穿入肱盂关节间隙(1.6%)。所有病例均无重要神经血管损伤、排异反应、内置物断裂、周围骨折等并发症。[结论]锁定钢板对肱骨近端骨折的张力侧固定作用,结合内侧柱有效支撑重建可以较好地恢复肱骨近端骨折固定后的力学稳定性,减少术后肱骨头内翻畸形等并发症的发生,临床疗效满意。更多还原

【Abstract】 [Objective]To discuss the clinical effect of reconstructing the medial column support and locking plate internal fixation to treat the proximal humerus fracture in the aged patients. [Method]Retrospective analysis was made on 62 patients in our department between August 2011 and September 2013. They were 28 men and 34 women,61 to 75 years of ages. According to the Neer classification,there were 13 cases of two- part fractures,29 cases of three- part and 20 cases of part four. Patients all used the locking proximal humeral plate( LPHP) internal fixation. X- ray was taken after surgery in the clinic at 1,3,6,9and 12 months. By measuring the loss of the head- shaft angle,Constant scores of the shoulder function,visual analog scale( VAS) pain scores,and complications related to the operation were recorded to analyze the effects.[Result]All cases got bone union at the last follow- up. On Constant scores,the excellent to good results rate were 79%,average of scores 82; VAS pain scores of( 2. 8 ± 2. 2); a mean loss of the humeral inversion angle of( 4. 5° ± 3. 1°),and 4 cases were more than 10°. The complication rate were 12. 9%. [Conclusion]Locking plate internal fixation and reconstructing the medial column support can better restore the mechanical stability of the proximal humeral fractures,reduce the occurrence of complications such as humerus head varus deformity and obtain good clinical effects.更多还原