高龄骨质疏松性肱骨近端三四部分骨折治疗的策略.docVIP

高龄骨质疏松性肱骨近端三四部分骨折治疗的策略 　　[摘要] 目的 探讨高龄骨质疏松性肱骨近端三、四部分骨折治疗策略。 方法 选取2006年1月～2013年1月100例高龄骨质疏松性肱骨近端骨折患者按随机数字表均分为两组。研究组使用人工肱骨头置换术，对照组采用微创PHILOS钢板内固定术，术后常规抗炎和康复治疗等。观察两组患者骨性愈合时间、术后并发症发生情况及肩关节功能评分情况。 结果 研究组在骨性愈合时间、术后并发症发生情况及肩关节功能评分方面优于对照组，差异有统计学意义（P0.05）。 结论 人工肱骨头置换术在治疗高龄骨质疏松性肱骨近端三、四部分骨折方面具有愈合快、术后并发症少、早期功能锻炼的优点，具有较好的疗效。 　　[关键词] 骨质疏松；肱骨近端骨折；人工肱骨头置换术；PHILOS 　　[中图分类号] R687.3[文献标识码] B[文章编号] 1673-9701（2014）18-0116-03 　　 　　The treatment strategies of senile osteoporotic fracture proximal humeral three or four parts 　　WEN Xile 　　Department of Orthopedic，Pingyang CountyPeoples Hospital in Zhejiang Province，Pingyang 325400，China 　　[Abstract] Objective To evaluate the treatment strategies of senile osteoporotic fracture proximal humeral three or four parts. Methods From January 2006 to January 2013，100 patients were randomly divided into two groups according to random number table（n=50）.The research group was treated by humeral head replacement. The control group was treated by minimally invasive percutaneous plate osteosynthesis philos plate. The bone healing，postoperative complications，Neer score in the two groups were reviewed and compared. Results The research group had better results in the aseptic necrosis of the bone healing，postoperative complications，neer scores than the control group. There were significant differences between the two groups（P0.05）. Conclusion Artificial humerus head replacement in the treatment of senile osteoporotic fracture proximal humeral three and part four has quick healing， the advantages of less postoperative complications， early functional exercise， have good curative effect. 　　[Key words] Osteoporosis; Proximal humeral fracture. Artificial humerus head replacement; PHILOS 　　肱骨近端骨折是指肱骨外科颈以远1～2 cm至肱骨头关节面之间的骨折，主要有大、小结节和肱骨头、干骺端四部分解剖结构，临床多依据这四部分骨折块的成角大小（成角45°）和移位程度（移位1cm）作为骨折分型[1]。肱骨近端骨折的治疗方法须考虑骨质疏松程度、功能恢复、全身情医况、肱骨头血运及软组织完整性等多方面因素， 目前医学界认为高龄骨质疏松性肱骨近端三、四部分骨折手术指征明确[2-3]，主要有人工肱骨头置换术（humeral head replacement，HHR）和钢板内固定术（proximal humeral internal