双钢板固定治疗老年复杂肱骨近端骨折

目的：探讨前内侧联合外侧锁定钢板治疗老年复杂肱骨近端骨折的疗效。方法 ：2018年6月至2020年10月，分别采用前内侧联合外侧锁定钢板（anteromedial combined with lateral locking plate,ALLP）及单纯肱骨近端锁定钢板（proximal humerus locking plates,PHLP）治疗各15例Neer 3、4部分肱骨近端骨折患者。其中男8例，女22例；年龄51～78 (61.5±7.5)岁。分为ALLP组和PHLP组。比较两组患者的临床资料与术后简明肩关节功能评分（simple shoulder test,SST）、肱骨头高度丢失值、内翻角及肩关节活动度。结果：所有骨折获骨性愈合。随访时间12～24 (14.3±2.9)个月。ALLP组手术时间较PHLP组长（P<0.05）。两组术中出血量比较差异无统计学意义（P>0.05）。术后1、3、12个月两组SST评分差异无统计学意义（P>0.05）。影像学测量方面，术后1、3个月，两组肱骨头高度丢失值及内翻角差异无统计学意义（P>0.05）；术后12个月时，...

Clinical study of double plate system in the treatment of complex proximal humeral fractures in the elderly

Objective To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery.Methods From June 2018 to October 2020,30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures,including 8 males and 22 females,aged from 51 to 78 years old with an average of (61.5±7.5) years old.Of them,15 patients had fractures fixed with anteromedial combined with lateral locking plate (ALLP group),whereas 15 received internal fixation with proximal humerus locking plate only (PHLP group).The clinical data,simple shoulder test (SST),humeral head height loss,varus angle and shoulder range of motion were compared between the two groups.Results All fractures were healed.The follow-up time ranged from 12 to 24 months,with an average of (14.3±2.9) months.The operation time of ALLP group was longer than that of PHLP group (P<0.05).There was no significant difference in intraoperative blood loss between the two groups (P>0.05).There was no significant difference in SST score between the two groups at 1,3 and 12 months after operation (P>0.05).In terms of radiographic measurement,there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05).At 12 months after operation,the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05).In shoulder range of motion,the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation (P<0.05).There was no significant difference in external rotation between the two groups.Conclusion Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis.But there are also disadvantages such as longer operation time,so it should be individualized according to the fracture type of the patient.