微创内固定治疗老年人肱骨近端粉碎性骨折

目的]探讨AO LPHP(locking proximal humerus plate,LPHP)钢板治疗老年人肱骨近端粉碎性骨折的微创内固定方法,并评估其疗效.方法]采用尽量暴露范围小的切口,应用AO LPHP锁定钢板进行可靠的内固定,对伴有肱骨头松质骨压缩缺损的患者同期进行植骨,对于伴有肩袖损伤的患者通过LPHP锁定钢板上定位孔利用胸骨缝线进行缝合固定,所有患者术后第1d即逐步进行肩关节功能锻炼.结果]全部病例肱骨大结节均无移位,1例患者肱骨小结节轻度移位,但终获愈合,肩关节功能:优16例,良8例,一般4例,差1例,优良率83%.结论]对于老年人肱骨近端粉碎骨折,早期恢复其肱骨近端解剖学结构和生物力学功能,是恢复患肢功能的有效治疗方法.

Treatment of comminuted fractures of the proximal humerus in elder patients with minimal invasive internal fixation

Objective] To study the method of treatment of comminuted fractures of the proximal humerus in older patients with minimal invasive internal fixation with AO LPHP and to evaluate its clinical effects.Method] All patients were surgically treated with minimal invasive internal fixation with AO LPHP. The cases with obvious osseous defects of the head of humerus were filled with bone, and the cases with impaired rotator cuffs were sutured through the positioning holes in AO LPHP with the nonabsorbable thoracic bone sutures. The shoulder joints' functional exercises of all the cases were begun gradually on the first day after operation.Result] No greater tuberosity of humerus was displaced during the period after operation. Only 1 case' lesser tuberosity of humerus was displaced slightly and it was healed at last. The joint function of shoulder was excellent in 16 cases, good in 8 cases, fair in 4 cases and poor in 1 case. The excellent and good rate was 83%.Conclusion]In dealing with comminuted fractures of the proximal humerus in older patients, early recovery of the anatomic structure and the function of vitodynamics of the proximal humerus is an effective treatment method to recover the function of the affected upper limb.