摘要目的 探讨锁定钢板联合同种异体腓骨髓内支撑治疗老年内翻型肱骨近端骨折的临床疗效. 方法 回顾性分析2015年5月至2017年7月广州中医药大学第二临床医学院骨科采用锁定钢板联合同种异体腓骨髓内支撑技术治疗21例老年内翻型肱骨近端骨折患者资料.男6例,女15例;年龄65 ～ 90岁,平均74.8岁;其中Neer二部分骨折2例,三部分骨折14例,四部分骨折5例.记录患者的手术时间、术中出血量、术后并发症及末次随访时功能评分,比较术前及术后、末次随访时肱骨颈干角及肱骨头高度的变化. 结果手术时间70 ～ 110 min,平均89.5 min;术中出血量160 ～400 mL,平均179.5 mL.21例患者术后获12 ～ 26个月(平均18.1个月)随访,伤口皆一期愈合,1例患者发生螺钉穿出,无神经、血管损伤、肩关节脱位、肱骨头坏死等并发症发生.末次随访时按Neer's肩关节功能评分系统评定疗效:优3例,良15例,可3例,优良率为85.7％.术后初次摄X线片颈干角为136.4°±5.8°,与术前颈干角(106.0°±7.3°)相比差异具有统计学意义(P＜0.05),与末次随访时颈干角(135.4°土6.5°)相比,差异无统计学意义(P＞0.05).术后初次摄片时钢板最上缘和肱骨头最上缘之间的距离为(1.6±0.2) mm,末次随访时为(1.54±0.22) mm,差异无统计学意义(P＞0.05). 结论采用锁定钢板联合异体腓骨髓内支撑技术可有效重建肱骨近端内侧柱,恢复颈干角,并且术中可以辅助复位、减少手术时间,术后可获得良好的肩关节功能,避免相关并发症的发生.

abstractsObjective To evaluate the clinical outcomes of locking plate combined with allogenic fibular intramedullary support in the elderly patients with varus proximal humeral fracture.Methods From May 2015 to July 2017,21 elderly patients with varus proximal humeral fracture were treated with locking plate combined with allogenic fibular intramedullary support at Department of Orthopaedics,The Second Clinical Medical College,Guangzhou University of Traditional Chinese Medicine.They were 6 men and 15 women,from 65 to 90 years of age (average,74.8 years).According to the Neer classification,2-part fracture was identified in 2 patients,3-part fracture in 14 and 4-part fracture in 5.Their operation time,amount of intraoperative bleeding,postoperative complications and functional scores at the last follow-up were recorded.The humeral neck angles and humeral head heights were compared between preoperation,postoperation and the last follow-up.Results Their operation time averaged 89.5 minutes (from 70 to 110 minutes) and intraoperative bleeding 179.5 mL (from 160 to 400 mL).They obtained follow-up from 12 to 26 months (average,18.1months).All the wounds were healed by the first intention.No such complications occurred as neurovascular lesion,shoulder dislocation or humeral head necrosis.However,screw cut-out was observed in one case.According to the Neer's scoring system,shoulder function was evaluated at the last follow-up as excellent in 3cases,as good in 15 and as fair in 3,giving a good to excellent rate of 85.7％.The humeral neck angle after operation was 136.4° ± 5.8°,significantly larger than the preoperative one (106.0° ± 7.3°) (P ＜0.05) but insignificantly different from the value at the last follow-up (135.4° ±6.5°) (P ＞ 0.05).The postoperative distance between the plate top and the humeral head top was 1.6± 0.2 mm,insignificantly different from that at the last follow-up (1.5 ± 0.2 mm) (P ＞ 0.05).Conclusion Locking plate combined with allogenic fibular intramedullary support can effectively reconstruct the medial proximal column of the humerus,restore the humeral neck angle,facilitate intraoperative fracture reposition and reduce operation time,leading to good functional recovery of the shoulder and prevention of related complications.