锁定钢板置入联合OsteoSet颗粒植骨及抗骨质疏松治疗老年性肱骨近端不稳定性骨折

背景：肱骨近端锁定钢板固定技术遵循了弹性生物学内固定的原则,适用于年轻人高能量粉碎性骨折及老年人骨质疏松骨折。目的：观察应用肱骨近端锁定钢板联合硫酸钙人工骨（OsteoSet颗粒）植骨及抗骨质疏松药物治疗老年性肱骨近端不稳定骨折的临床效果。方法：26例老年性肱骨近端骨折患者按Neer分类标准进行分型：二部分骨折17例,三部分骨折7例,四部分骨折2例。患者入院后均予以抗骨质疏松治疗,以肩部X射线片、CT及放射吸收法指骨骨密度检测,于伤后5~10d行切开复位肱骨近端锁定钢板内固定＋OsteoSet颗粒植骨治疗。结果与结论：26例患者治疗前采用放射吸收法测量骨量减少占4%（1例）、骨质疏松占96%（25例）。治疗后均随访12个月以上。内固定及植骨后Neer评分,二部分骨折优良率为94%,三、四部分骨折优良率为66%。所有患者无感染、内固定松动断裂、骨折不愈合及肱骨头坏死等,骨折愈合时间为2.5~7个月。结果提示：①肱骨近端锁定钢板联合OsteoSet颗粒植骨及抗骨质疏松药物治疗老年性肱骨近端骨折的临床效果满意。②放射吸收法指骨骨密度检测利于骨折患者术前骨质疏松的筛查。

Locking proximal humerus plate combined with OsteoSet and anti-osteoporosis treatment for proximal humeral unstable fracture in aged patients

BACKGROUND： Locking proximal humerus plate （LPHP） fixation follows the principles of elastic biological internal fixation. It is suitable for the youth comminuted fracture and aged osteoporotic fracture. OBJECTIVE： To observe the clinical effect of LPHP combined with calcium sulfate （OsteoSet） and anti-osteoporosis treatment for proximal humeral unstable fracture of aged patients. METHODS： Twenty-six cases of aged proximal humeral fractures were treated with type classification according to Neer classification criteria： 17 cases with two-part fracture, 7 cases with three-part fracture and two cases with four-part fracture. All the patients were treated with anti-osteoporosis treatment which was detected by X-ray and CT of shoulders and radiographic absorptiometry of phalanges bone mineral density. At 5-10 days after fracture, LPHP internal fixation combined with OsteoSet were used for the treatment of proximal humeral unstable fracture. RESULTS AND CONCLUSION： Bone mass of 26 patients was decreased 4% （1 case） by radiographic absorptiometry detection and osteoporosis was 96% preoperatively. All the patients were follow-by over 12 months postoperatively. The Neer score showed that the good-excellent rate was 94% in the two-part fracture, and 67% in the three or four-part fracture. There were no incision infection, disunion of internal fixation and humeral head necrosis happened, all the fractures had united in 3.8 months （from 2.5 to 7 months）. It is indicated that： ①The clinical effect of LPHP combined with OsteoSet and anti-osteoporosis treatment on proximal humeral unstable fracture of aged patients is satisfactory. ②Radiographic absorptiometry of phalanges bone mineral density detection is beneficial to the screening for fracture patients osteoporosis preoperatively.