【作者】 陈鹏； 田晓滨； 胡如印；

【机构】 贵州省人民医院骨科；

【摘要】 目的:探讨在肱骨近端复杂骨折手术方式选择,评价肱骨近端锁定钢板(Locking Proximal Humeral Plate,LPHP)内固定与人工半肩关节置换(Hemiarthroplasty of shoulder)手术适应症及临床疗效。方法:回顾贵州省人民医院自2008年2月至2012年1月手术治疗肱骨近端复杂骨折患者63例,其中男36例女27例,年龄21-81岁,平均年龄51岁,年龄>70岁合并骨质疏松或骨量丢失表现21例,行人工半肩关节置换8例,LPHP内固定55例,术后行颈腕带悬吊3周,并指导病人行肩关节功能锻炼,术后1月,半年复查肩关节X线片,均获得随访,时间6-18个月(平均12个月),术后病人按Neer肩关节功能评分标准评价随访肩关节功能。结果:9例出现钢板松动,5例出现肱骨头缺血坏死。结论:对于肱骨近端骨折,LPHP及人工半肩关节置换为两种重要的治疗方式,但在选择上需要综合患者的年龄、骨量以及全身情况合理评估,笔者通过临床观察发现:对于年龄>70岁合并有骨质疏松或骨量明显减少的病人选择一期肩关节置换临床疗效较好,对于年龄<70岁病人无明显骨质疏松或骨量减少的病人选择LPHP内固定临床疗效较好。更多还原

【Abstract】 Objective to investigate the methods of operative treatment for complicated proximal humeral fractures,to evaluate the indications and the clinical outcome of Locking Proximal Humeral Plate(LPHP) treatment and hemiarthroplasty of shoulder treatment.Methods:Review 63 cases of complicated proximal humeral fractures in Gui zhou Provincial People’s Hospital from February 2008 to January 2012,In detail,there are 36 male patients and27 female,age 21-81 years,average age 51 years,21 cases with osteoporosis or bone loss and age > 70 years,in these cases,there are 8 cases with hemiarthroplasty of shoulder treatment,55 cases with LPHP treatment,Immobilize the arm in a single for 3 weeks after operation,guide the patients exercise the passive movement and active movement of the shoulder,review the patients clinically and radiologically after 6 months.Results All patients were followed up to 6-12Months(mean 12 months),the clinical efficacy was evaluated according to the Neer’s score system,result:9 cases with the loosening or breakage of the plate,5 case with Humeral head necrosis.Conclusion for proximal humeral fractures:LPHP and shoulder hemiarthroplasty was two important treatment,but the indication of operative methods should be chosen according to the age,bone volume and conditions of whole body of the patients.Through the clinical observation,the author found:hemiarthroplasty of shoulder treatment can achieve good clinical outcomes in patients age > 70 years with osteoporosis or bone loss and LPHP treatment can achieve good clinical outcomes in patients age < 70 years without osteoporosis or bone loss.更多还原