摘要
目的 分析老年肱骨近端粉碎性骨折采取锁定钢板+同种异体腓骨髓内移植治疗的效果。方法 选取2020年8月至2022年7月收治的老年肱骨近端粉碎性骨折患者60例，随机分为 观察组和对照组各30例，对照组给予锁定钢板治疗，观察组采取锁定钢板+同种异体腓骨髓内移植治疗，对比效果。结果 ①颈干角。观察组术后初次、末次复查颈干角度高于对照组，但颈干角差值低于对照组（P值均<0.05）；②肱骨头相对钢板高度。观察组末次复查高度高于对照组（P<0.05）；③骨折愈合时间。观察组骨折愈合时间低于对照组（P<0.05）；④并发症。观察组并发症发生率低于对照组（P<0.05）；⑤疼痛及功能评分。观察组DASH评分及VAS评分均低于对照组，但CMS评分高于对照组（P值均<0.05）。结论 锁定钢板与同种异体腓骨髓内移植对老年肱骨近端粉碎性骨折患者治疗可有效改善其肢体功能，降低并发症，减轻痛苦。
关键词： 老年肱骨近端粉碎性骨折；并发症；锁定钢板；骨折愈合时间；同种异体腓骨髓内移植；颈干角
Abstract
Objective To analyze the effect of locking plate and allograft fibula transplantation in the treatment of proximal humeral comminuted fracture in the elderly. Methods 60 elderly patients with comminuted proximal humeral fracture admitted from August 2020 to July 2022 were randomly divided into the observation group and the control group, with 30 cases in each group. The control group was treated with locking plate, and the observation group was treated with locking plate+allograft fibula bone marrow transplantation, and the effects were compared. Results ① cervical trunk angle. The angle of neck shaft in the observation group was higher than that in the control group at the first and last reexamination after operation, but the difference of neck shaft angle was lower than that in the control group (P<0.05); ② Height of humeral head relative to steel plate. The height of the last reexamination in the observation group was higher than that in the control group (P<0.05); ③ Fracture healing time. The time of fracture healing in the observation group was lower than that in the control group (P<0.05); ④ Complications. The incidence of complications in the observation group was lower than that in the control group (P<0.05); ⑤ Pain and function scores. DASH score and VAS score in the observation group were lower than those in the control group, but CMS score was higher than that in the control group (P<0.05). Conclusion Locking plate and allograft fibular bone marrow transplantation can effectively improve limb function, reduce complications and alleviate pain in elderly patients with comminuted proximal humeral fracture.
Key words： Comminuted proximal humeral fracture in the elderly; complication; Locking steel plate; Fracture healing time; Allogeneic fibular bone marrow transplantation; Angle of cervical trunk
参考文献 References
[1] 冯立卫,赵树勇,孙同伟,等. 自体髂骨瓣重建联合锁定钢板内固定治疗"头帽型"肱骨近端骨折1例[J]. 中国骨与关节损伤杂志,2021,36(5):549-550.
[2] 王飞,许功效,戴履旺. 锁定钢板联合药物抗骨质疏松治疗老年肱骨近端粉碎性骨折的临床疗效[J]. 川北医学院学报,2020,35(6):1059-1062.
[3] 张涵,何斌,王云华,等. 手法复位结合微创T型小切口锁定钢板治疗老年肱骨外科颈骨折的临床观察[J]. 实用老年医学,2020,34(7):712-714.
[4] 隋洪国. 老年肱骨近端粉碎性骨折患者采用中医结合锁定钢板结合异体腓骨治疗的临床效果[J]. 中国伤残医学,2021,29(12):55-56.
[5] 安雪军,徐宝山,王小健,等. 保守治疗、钢板固定与人工肱骨头置换治疗老年肱骨近端复杂骨折的疗效比较[J]. 实用医学杂志,2020,36(5):613-618.
[6] 韩巍,张腾,米萌,等. 同种异体腓骨移植预防老年粉碎性肱骨近端骨折术后内翻及塌陷的效果[J]. 中国医药导报,2021,18(18):88-91.
[7] 常祖豪,朱正国,齐红哲,等. 锁定钢板结合异体腓骨治疗老年肱骨近端粉碎性骨折的中远期疗效观察[J]. 解放军医学院学报,2019,40(2):106-112.
[8] 张继源. 对比老年肱骨近端粉碎性骨折实施人工肱骨头置换与锁定加压钢板内固定的临床效果[J]. 世界最新医学信息文摘（连续型电子期刊）,2019,19(56): 127-128.
[9] 任洋良,张俊,李阳,等. 半肩关节置换与philos钢板内固定治疗对老年肱骨近端粉碎性骨折的临床疗效观察[J]. 实用医院临床杂志,2021,18(5):107-111.
[10] 王尧,曹烈虎,崔进,等. 锁定钢板联合同种异体腓骨植骨与半肩关节置换治疗老年复杂肱骨近端骨折疗效的对比研究[J]. 中华肩肘外科电子杂志,2019,7(2):128-135.