肱骨近端锁定加压钢板与解剖钢板治疗老年肱骨外科颈骨折的疗效比较

目的比较肱骨近端锁定加压钢板与解剖钢板治疗老年肱骨外科颈骨折的临床疗效。方法将50例老年肱骨外科颈骨折患者按治疗方法分为两组,使用肱骨近端锁定加压钢板治疗(锁定钢板组)25例,使用肱骨近端解剖钢板治疗(解剖钢板组)25例,比较两组手术时间、术中出血量、术后住院天数、术后骨折愈合时间、术后关节活动度、术后3个月Neer肩关节功能评分及术后并发症的情况。结果 50例均获得随访,时间12~18(13.5±4.1)个月。手术时间(min):锁定钢板组为55.3±23.7,解剖钢板组为73.7±30.3,P0.05。术中出血量(ml):锁定钢板组为189.5±34.5,解剖钢板组为273.2±39.8,P0.05。术后住院时间(d):锁定钢板组为8.3±3.1,解剖钢板组为10.5±4.2,P0.05。术后骨折骨性愈合时间(d):锁定钢板组为97.2±23.8,解剖钢板组为119.5±34.5,P0.05。肩关节活动度:锁定钢板组优于解剖钢板组(P0.05)。术后3个月采用Neer肩关节功能评分进行比较:锁定钢板组优良率为23/25,解剖钢板组优良率为21/25,两组比较差异无统计学意义(P0.05)。术后并发症:锁定钢板组无肱骨头缺血坏死,无内固定松动及断裂;解剖钢板组出现螺钉松动退钉1例,钢板断裂1例。结论肱骨近端锁定加压钢板设计合理,操作简便,同时具有固定和加压作用,固定牢固,可早期功能锻炼,肩关节功能恢复良好,术后骨折愈合快,治疗老年肱骨外科颈骨折疗效更好。

Clinical effect comparison of the proximal humeral locking compression plate and the proxi-mal humeral anatomical plate in the treatment of proximal humeral fracture in aged osteopo-rotic population

Objective To compare clinical effect of locking compression plate （LCP） of proximal humerus and anatomical plate （AP） of proximal humerus in elderly osteoporotic population. Methods 50 elderly osteoporotic patients with proximal humeral fracture were treated with LCP （25cases） and AP （25 cases） respectively. The operation time, intraoperation bleeding, postoperative time of hospitalization, postoperative fracture healing time, postoperative rang of motion （ROM） of shoulder, postoperative complication and Neer scores in 3 months after surgery were observed. Result All patients were followed up for 12 - 18 （ 13.5 ± 4. 1 ） months. The operation time in LCP group was （55.3 ±23.7） min and AP group was （73. 7 ±30. 3） min,P 〈0. 05. The blood loss in LCP group was （ 189. 5 ±34. 5 ） ml and AP group was （273.2 ± 39. 8 ） ml, P 〈 0. 05. The time of hospitalization in LCP group was （ 8. 3 ±3. 1 ） d and AP group was （ 10. 5 ±4. 2 ） d, P 〈 0.05. The postoperative fracture healing time in LCP group was （97. 2 ±23.8 ） d and AP group was （119. 5 ±34. 5 ） d, P 〈 0. 05. There was statistically differences between two groups of ROM of shoulder （ P 〈 0. 05 ）. The shoulder function was examined and evaluated with Neer score in 3 months postoperative, the excellent and good rate in LCP group was 23/25 and AP group was 21/25, which was no significant differences （P 〉 0. 05 ）. No instrument failure was found in LCP group and 2 cases developed instrument failure in AP group. No complication such as avascular necrosis of the humeral head or internal fixation failure were found in LCP group,and there was 1 case developed screw loose and 1 case developed plate fraeture in AP group. Condusions Compared with the AP, LCP in treating proximal humeral fractures have advantages of reasonable design, simple operation, strong fixation, faster fracture healing, and also can let shoulder function exercise early. It is an more effective method to treat proximal humeral