锁定钢板治疗Neer 3、4部分肱骨近端骨折的病例对照研究

目的：比较运用锁定钢板治疗Neer 3、4部分肱骨近端骨折的疗效。方法：自2009年1月至2011年6月，采用锁定钢板治疗64例Neer 3、4部分肱骨近端骨折。3部分骨折组39例，男16例，女23例；平均年龄（55.12±12.52）岁。4部分骨折组25例，男9例，女16例；平均年龄（57.92±13.14）岁。随访根据美国肩肘外科医师评分（American Shoulder and Elbow Surgeons score，ASES）评估患者肩关节功能，采用视觉模拟评分法（visual analogue scale，VAS）进行疼痛评分，并评价相关并发症。结果：术后患者切口均I期愈合。64例均获随访，时间12～30个月，平均16.5个月。末次随访时，ASES评分3部分骨折（76.14±14.10）分，4部分骨折（65.93±11.82）分；VAS评分分别为2.12±1.63和3.90±2.21，以上指标两组比较差异均有统计学意义（P〈0.05）.并发症发生率分别为20.51%和36.00%，差异无统计学意义。结论：锁定钢板治疗肱骨近端3部分骨折的疗效优于4部分骨折，术中需争取解剖复位、稳定固定、选择合适长度的螺钉及钢板位置，术后合理功能锻炼以获得良好的疗效。

Case-control study on locking plates fixation for the treatment of Neer 3-and 4-part proximal humerus fractures

Objective： To compare therapeutic effects of locking plates for the treatment of Neer 3-and 4-part proximal humerus fractures. Methods： From January 2009 to June 2011,64 patients with Neer 3-and 4-part proximal humerus fractures were treated with locked plate fixation. There were 39 patients in the 3-part group including 16 males and 23 females,with an average age of（55.12±12.52）years old;and 25 patients in the 4-part fractures group including 9 males and 16 females,with an average age of（57.92 ±13.14） years old. The American Shoulder and Elbow Surgeons score（ASES）,visual analogue scale（VAS）and complications were documented for analysis before and after treatment. Results： All the patients had incision healing at the first stage. All the patients were followed up,and the duration ranged from 12 to 30 months,with a mean of 16.5 months. Comparably better shoulder function recovery was achieved in the 3-part fractures group with regard to the ASES（76.14±14.10 in the 3-part fractures group vs. 65.93 ±11.82 in the 4-part fractures group,P〈0.05）. Moreover,a statistical difference（P〈0.05） was observed regarding the VAS pain score（2.12±1.63 in the 3-part fractures group vs. 3.90±2.21 in the 4-part fractures group）. For the complications rate,no statistical difference was noted between 3-part fractures group and 4-part fractures group（20.51% vs. 36.00%）.
Conclusion： The clinical outcomes of the 3-part proximal humerus fractures is better than the 4-part fractures proximal humerus fractures treated with locking plate. Complex proximal humeral fractures treated with locking plates can be achieved a satisfactory outcome when attention is paid to anatomic reduction,stable fixation,proper screws and plate placement,and reasonable functional exercise postoperative.