老年肱骨近端骨折闭合复位内固定的治疗观察

目的探讨老年肱骨近端骨折内固定治疗方法及其疗效。方法将2010年2月至2011年6月经首都医科大学密云教学医院确定为肱骨近端骨折的27例老年患者作为研究对象,其中行切开复位肱骨近端内固定系统(PHILOS)钛板固定治疗的患者为切开复位组(16例),行闭合复位肱骨近端交锁髓内钉内固定治疗的患者为闭合复位组(11例),比较两组患者治疗后骨性愈合及并发症情况。结果闭合复位组患者骨性愈合率、愈合时间及开始功能锻炼的时间与切开复位组比较,差异均有统计学意义(χ2=3.267,t=4.215、30326,P<0.05);闭合复位组的并发症发生率显著低于切开复位组(9.09%vs 31.25%,χ2=11.05,P<0.05);12个月后随访发现,闭合复位组术后肩关节运动评分的优良率为90.90%(10/11),切开复位组为81.25%(13/16),两组比较差异有统计学意义(χ2=3.427,P<0.05)。结论老年肱骨近端骨折的治疗需根据骨折的严重程度选择恰当的治疗方法,在相同的条件下,老年患者选择闭合复位肱骨近端交锁髓内钉治疗效果显著,骨性愈合率高,功能恢复好,值得临床推广。

The Effect of Closed Reduction Internal Fixation for Treatment of Proximal Humeral Fracture among Elder Patients

Objective To discuss the effect of internal fixation with transfix ion pin for treatment of proximal humeral fracture. Methods A total of 27 patients with proximal humeral fracture from Miyun Hospital during Feb. 2010 to Jun. 2011 treated by two different methods were included in the research. 11 patients treated with proximal humeral nailing system were the closed reduction group, and 16 patients treated with proximal humeral internal locking system were the open reduction group. The bone healing and compli- cations after surgery were observed. Results The rate of bone healing,time of healing and functional exercise of the closed reduction group were better than that of open reduction group（ X2 =3. 267 ,t=4. 215,30326,P 〈 0.05 ）, and the incidence of complications was lower than the open reduction group （9.09% vs 31.25 % ） （ X2 = 11.05,P 〈 0.05 ）. The total effective rate of dosed reduction （90.90%） was better than the control group（ 81.25% ） after 12 months following study （ X2 = 3. 427, P 〈 0.05 ）. Conclusion The treatment of elderly proximal humerus fractures is based on the severity of fractures. Under the same conditions, the effects of closed reduction of proximal humeral intramedullary nailing is obvious, and the bone union rate, functional recovery are better than others, thus is worthy for spreading.