肱骨近端锁定钢板结合同种异体腓骨头髓腔植入治疗老年粉碎性肱骨近端骨折

目的探讨肱骨近端锁定钢板（locking proximal humerus plate，LPHP）结合深冻同种异体腓骨头髓腔内植入治疗老年粉碎性肱骨近端骨折的疗效。方法2010年1月至2012年6月，采用LPHP结合深冻同种异体腓骨头髓腔内植入治疗15例老年粉碎性肱骨近端骨折。其中男6例，女9例，年龄62～85岁，平均73岁。致伤原因：摔伤11例，交通事故4例。所有患者均有骨质疏松，骨折均为粉碎性，内侧壁均缺少支撑，复位比较困难；Neer分型：三部分骨折7例，四部分骨折8例，其中骨折伴肩关节脱位4例。结果手术时间60—180rain，平均95min；术中出血量100～500ml，平均240ml。患者术后伤口均一期愈合，无免疫排斥反应，无感染、血管及神经损伤等早期并发症发生。所有患者随访15—30个月，平均19个月。x线片检查示骨折均获得骨性愈合，未见明显复位丢失和骨折再移位，未见螺钉固定失效或切出，未见肱骨头坏死。术后12个月患肢肩关节功能按照Neer评分系统进行评价，优良13例，可2例，优良率为86．7％。结论LPHP结合同种异体腓骨头髓腔植入治疗老年粉碎性肱骨近端骨折疗效满意。

An intramedullary fibular head allograft together with a locking proximal humerus plate fixation for complicated fractures of the proximal humerus in elderly patients

Objective To investigate the effects of a deep-frozen intramedullary fibular head allograft together with a locking proximal humerus plate （ LPHP ） fixation in the treatment of comminuted fractures of the proximal humerus in elderly patients. Methods From January 2010 to June 2012, 15 elderly patients with comminuted fractures of the proximal humerus were treated with a LPHP together with a deep-frozen intramedullary fibular head allograft. There were 6 males and 9 females, whose mean age was 73 years old （ range; 62-85 years ）. Fractures were caused by failing in 11 cases and traffic accidents in 4 cases. All patients had osteoporosis and comminuted fractures, with loss of the medial column mechanical support. As a result, the reduction was relatively difficult. According to the Neer classification, 7 patients had 3-part fractures and 8 patients had 4-part fractures. Fractures combined with shoulder dislocation occurred in 4 cases. Results The operation time was 60-180 minutes with an average period of 95 minutes. The blood loss was 100-500 ml during the operation with an average amount of 240 ml. All incisions healed by first intention postoperatively, and no early complications such as immunological rejection, infection or neurovascular injuries were found. All patients were followed up for 19 months on average （ range; 15-30 months ）. Based on the X-ray films, all fractures got union, without obvious loss of reduction or fracture displacement, screw fixation failure or cut-out or humeral head necrosis. According to the Neer shoulder fimction scoring system, the results were excellent in 13 cases and fair in 2 cases at 1 year after the operation. The excellent and good rate was 86.7%. Conclusions The effects of a deep-frozen intramedullary fibular head allograft together with a LPHP fixation were satisfactory in the treatment of comminuted fractures of the proximal humerus in elderly patients.