摘要
目的:探讨应用关节囊外间接复位经皮肱骨近端锁定钢板(LPHP)固定治疗老年性肱骨近端3、4部分骨折的疗效。方法:自2004年11月至2008年5月,应用关节囊外间接复位经皮LPHP固定技术治疗老年性肱骨近端3、4部分骨折24例,男6例,女18例;年龄55～88岁,平均70岁。手术采用肩外侧横切口经三角肌入路,关节囊外正骨手法将骨折复位后,将LPHP从切口内插入,然后远端做切口暴露钢板远端,近端4～6枚螺钉固定,远端3枚螺钉固定。术后2～3d患肩开始被动活动,2周后开始主动活动,3周后加强功能锻炼。应用Constant评分系统对肩关节进行功能评定。结果:所有骨折均愈合,平均愈合时间10.5周(8～21周),Constant评分49～92分,平均81.6分。其中优7例,良13例,中3例,差1例。结论:关节囊外间接复位结合LPHP内固定具有固定稳定、操作简单和血运破坏少等优点,能够有效治疗肱骨近端3、4部分骨折,特别适用老年骨质疏松患者。
Objective：To evaluate the treatment effect of three and four part fractures of proximal humerus in elder patients using indirect reduction combined with locking proximal humeral plate（LPHP） fixation. Methods：From November 2004 to May 2008,24 cases of proximal humeral three and four part fracture were treated with percutaneous plate fixation using LPHP included 6 males and 18 females with an average age of 70 years old ranging from 55 to 88 years. The surgery was performed through antrolateral transdeoltoid approach. After extra articular capsule indirect reduction,the plate was inserted through the incision, and then an incision was made distal to previous incision to expose distal plate. The proximal fragments were fixed with 4 to 6 screws,and distal fragments were fixed with 3 screws. Shoulder exercises were performed at the 2nd to 3rd day after operation. Two weeks after operation,active shoulder exercise was done,which was gradually intensified 3 weeks after operation. The functional outcomes of the shoulder were assessed according to Constant score. Results：All the fractures united clinically and radiologically. The mean healing time was 10.5 weeks （8 to 21 weeks）. The mean Constant score was 81.6 points （49 to 92 points）. A total of 20 patients had excellent or satisfactory result,with only one scored as poor. Conclusion： The technique of extra articular capsule indirect reduction combined LPHP internal fixation has the advantages of stable,easy to operate,less vascular damage and so on. It can effectively treat the proximal humerus three and four part fractures,especially to elder patients.
出处
《中国骨伤》
CAS
2010年第4期298-301,共4页
China Journal of Orthopaedics and Traumatology
关键词
肱骨近端骨折
骨折固定术
内
骨质疏松
Proximal fracture of humerus
Fracture fixation
internal
Osteoporosis
