高龄肱骨近端骨折患者的外科治疗

目的采用锁定加压钢板(LCP)结合规范抗骨质疏松方案治疗高龄肱骨近端骨折,评估近期疗效。方法 2008年1月～2010年6月,对46例肱骨近端骨折行切开复位内固定术治疗,其中男16例,女30例,年龄68～87岁,平均年龄76.5岁。骨折采用Neer分型,两部分骨折26例,三部分骨折12例,四部分骨折8例。术前骨密度测量(DEXA)值为0.52～0.86g/cm2,平均0.68±0.14g/cm2,提示本组均达到重度骨质疏松的诊断标准。采用肱骨近端锁定加压钢板固定,骨缺损严重者予Wright人工骨粒植入。术后早期行肩关节康复功能锻炼,同时予鲑鱼降钙素、钙剂、维生素D行规范抗骨质疏松治疗。结果本组肱骨近端骨折均满意复位,术后无肱骨头坏死和感染等并发症发生。根据Neer肩关节功能评分,优32例,良11例,可3例,优良率93.5%。术后随访1年～3年6个月,平均2年,所有患者均获骨性愈合,骨折复位无丢失,肩关节功能恢复满意。结论 LCP结合规范抗骨质疏松治疗高龄肱骨近端骨折,具有创伤小、固定可靠、可早期康复功能锻炼等优点,近期疗效满意。

Surgical treatment for elderly patients with fractures of the proximal humerus

Objective To evaluate the clinical outcomes of the fractures of the proximal humerus using locking compression plate(LCP) and standard anti-osteoporosis therapy.Methods 46 cases(male 16 and female 30) of the fractures of the proximal humerus,whose average age was 76.5 years old(range from 68 to 87),which were treated with open reduction and internal fixation with LCP from January 2008 to June 2010.According to Neer classification,26 cases were partⅡ,12 cases were part Ⅲ,8 cases were partⅣ.The preoperative bone mineral density(DEXA) values: 0.52~0.86g/cm2,an average of 0.68±0.14g/cm2,which suggested the existence of severe osteoporosis.The serious damaged bone was treated with Wright artificial implant.Early rehabilitation training of shoulder and standard anti-osteoporosis with salmon calcitonin,calcium and Vitamin D were recommended postoperatively.Results The proximal humerus fracture was satisfied with the reduction.No humerus head osteonecrosis and infection occurred.The clinical outcomes were evaluated according to Neer grading,32 cases were graded as excellent,good in 11 cases and 3 cases.The overall satisfactory rate was 93.5%.All patients were followed up for 2 years(range from 1 to 3 years and 6 months).All cases were healed without reduction loss.The shoulder joint function was satisfactory.Conclusion Because of reliable fixation,minimal invasive and early rehabilitation training of shoulder,LCP with standard anti-osteoporosis therapy has been proven as a safe and effective method for treatment of fractures of the proximal humerus.