两种不同钢板治疗不同年龄段肱骨近端C2型骨折的疗效观察

目的比较锁定钢板(Locking proximal humeral plate,LPHP)及普通加压钢板,治疗不同年龄段肱骨近端C2型骨折的临床疗效。方法2004年1月至2009年6月,对152例肱骨近端C2型骨折患者,按年龄分为青少年段(<30周岁)、中年段(30~60周岁)及老年段(>60周岁);每个年龄段再随机分为A、B两组,A组77例患者采用锁定钢板治疗,B组75例患者采用普通钢板治疗。通过骨折愈合率及Neer评分,比较分析各组及每个年龄段的疗效。结果术后随访18~24个月。A组青少年段、中年段的骨折愈合率与B组比较均无统计学差异(P>0.05);A组的老年段骨折愈合率为97.1%,明显高于B组的81.8%(P<0.05)。A、B两组青少年段的Neer疗效评分无显著差异(P>0.05);A组其他两个年龄段的Neer疗效评分明显高于B组(P<0.05)。结论锁定钢板治疗中老年肱骨近端C2型骨折较普通钢板更为安全有效,中老年段肱骨近端C2型骨折患者建议使用锁定钢板治疗。

LPHP and LC-DCP for the Treatment of Proximal Humeral Fractures in Patients with Different Age

Objective To compare the clinical effects of locking proximal humeral plate(LPHP) and normal plate for the treatment of C2 type proximal humeral fractures in patients with different age.Methods Since January 2004 to June 2009,152 patients with C2 type proximal humeral fractures were divided into three age groups: youth(<30),middle-aged(30~60) and old(>60).Each age group was randomly divided into two groups: 77 cases in group A were treated by LPHP and 75 cases in group B were treated by normal plate.Fracture healing rate and Neer score were assessed to compare the clinical effects in different age groups of each group.Results All the patients were followed up for 18 to 24 months.There was no statistical difference in fracture healing rate between group A and group B in youth and middle-aged age groups(P>0.05),while in old age group,the fracture healing rate of group A(97.1%) was significantly higher than group B(81.8%)(P<0.05).According to Neer criteria,there was no statistical difference in Neer score between two groups in youth age group(P>0.05),but group A had clearly higher scores than group B in other two age groups(P<0.05).Conclusion Compared to normal plate,LPHP is much safer and more effective in the treatment of middle and old aged patients with C2 type proximal humeral fractures.