摘要
目的探讨锁定板治疗老年肱骨近端三部分、四部分骨折疗效及预后。方法回顾性分析2005年1月-2012年1月期间45例年龄〉60岁,Neer三部分、四部分肱骨近端骨折患者,均采用切开复位锁定接骨板手术治疗,术后随访根据肩关节简单评分问卷和Constant-Mudey评分等对肩关节功能进行评估。结果 43例患者获得门诊随访,随访时间12~48个月,平均18个月。患者患侧Constant评分为（72.3±9.5）分,6例（14.0%）患者需翻修手术。影响肩关节功能评分因素除了骨折类型外,还有再移位4例（9.3%）、不愈合3例（7.0%）、撞击3例（7.0%）、肱骨头坏死6例（14.0%）、螺钉进入肩关节5例（11.6%）。6例肱骨近端内侧柱损伤患者中3例发生骨折再移位、2例骨折不愈合和2例螺钉进入关节腔,终末随访4例患者需翻修手术治疗,占翻修患者的2/3。结论虽然锁定接骨板治疗老年肱骨近端三部分、四部分骨折疗效肯定,但并发症多,医生应根据患者实际情况、骨折分型以及医生自身情况选择治疗方案。手术治疗需注重肱骨近端骨折的解剖复位、螺钉及钢板位置、螺钉长度、内侧柱支撑及稳定性,这是获得良好功能、降低并发症的关键因素。
Objective To analyze the outcome and prognostic factors of using locking plate for treating proximal humerus fracture. Methods Between January 2005 and January 2012, 45 aged patients with a displaced 3-part or 4-part fracture of the proximal humerus were treated by locking plate. Range of motion and Constant-Mudey score were observed during the follow-up. Results Forty-three patients were followed up from 12 to 48 months with an average of 18 months. The mean final Constant-Mudey score was 72.3±9.5 and 6 of them needed a second surgery. In addition to fracture type, other prognostic factors included redisplacement（4 cases, 9.3%）, nonunion（3 cases, 7.0%）, crashing（3 cases, 7.0%）, necrosis of the humeral head（6 cases, 14.0%） and screw cut-out（5 cases, 11.6%）. Among the patients with disrupted medial calcar, 4 needed a second surgery at the final follow-up, 3 had redisplacement, 2 had nonunion, and2 had screw cut-out. Conclusions Locked screw-plates provide more secure fixation of fracture in aged patients, but the complication rate remains high. We suggest anatomic reduction, and plate and screws position, lengtThof the screws, the medial cortical contact and stability may be the chief prognostic factors affecting the shoulder function following a proximal humeral fracture.
出处
《华西医学》
CAS
2015年第3期417-420,共4页
West China Medical Journal
关键词
肱骨近端骨折
老年
疗效
预后因素
Proximal humerus fracture
Elder patient
Clinical outcome
Prognostic factors
