老年人肱骨近端粉碎性骨折的外科治疗

目的] 比较老年人肱骨近端粉碎性骨折内固定方法，评价“三叶草”型钛钢板内固定结合植骨的治疗效果。方法] 对47例老年人肱骨近端粉碎性骨折患者分别应用克氏针、螺钉内固定和“三叶草”型钛钢板内固定结合植骨术(自体骨、金世植骨灵)治疗。42例得到随访，平均随访时间2．4a，采用Neer分型和评定标准分析疗效。结果]钢板内固定、植骨术组全部4个月内骨折愈合，克氏针、螺钉内固定术组7例骨不连；32例(32／42)术后肩关节不同程度僵硬。Neer 3、4部骨折(18例)应用克氏针螺钉内固定，优良率为38．4％和20％；“三叶草”型钛钢板 植骨(24例)，优良率为77．7％和50％。结论]老年人肱骨近端粉碎性骨折，其主要病理变化是骨质疏松和骨折部位骨缺损，宜早期手术治疗。与克氏针、螺钉内固定方法比较，“三叶草”型钛钢板独特的韧性和构型，其近端“筛孔”任意角度穿钉的锚固作用符合AO内固定原则，同时植骨促进骨愈合，是老年肱骨近端粉碎性骨折有效治疗方法。

Surgical treatment of splintered fracture of proximal humerus for the elderly people

Objective]To evaluate the therapeutic effect of proximal humerus fracture of the elderly people with the fixation of a steel bar and bone graft. Method] The inner fixation with the Kirschner needle and steel screw, or the inner fixation with the steel bar and the bone graft (auto genans bone or jin shi zhi gu ling) were performed respectively in 47 elderly patients with splintered fracture of proximal humerus. The averaged following up time was 2.4 years. The therapeutic effects were analyzed by Neer styling system and relevant standards. All cases were Neer 3 or Neer 4 grades. Result] The excellent and good rate of therapeutic effects was 38.4% and 20.0% respectively in 18 cases performed with fixation with Kirschner needle and steel screw; the excellent and good rate was 77.7% and 50.0% respectively in 24 cases performed with the inner fixation and with steel bar and bone graft Conclusion] The splintered fracture of proximal humerus of the elderly people often combined with severe osteoporosis and bone defect. The fixation with steel bar, which can be screened throuth the orbital canals, match the request of strong fixation and can fasten the bone union.