Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China.
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, No. 8 GongTiNanLu, Beijing 100020, China.
Biomed Res Int. 2018 Sep 16;2018:3130625. doi: 10.1155/2018/3130625. eCollection 2018.
The objective of this study was to compare the clinical outcomes and complications between the locking compression plate (LCP) and LCP with fibular allograft in the treatment of patients with displaced proximal humerus fracture (PHF) in elderly people.
Between January 2010 and December 2013, a total of 97 elderly patients with displaced PHF were treated by LCP or LCP with fibular allograft, and finally 89 patients were included in our study. All the patients were divided into Group I (patients treated by LCP) and Group II (patients treated by LCP with fibular allograft). Function results were assessed by the disability of the arm, shoulder, and hand (DASH) score and Constant-Murley score (CMS), and complications were also recorded in each group.
The average follow-up was 35.2 months (range, 24-48 months) in Group I and 33.5 months (range, 24-48 months) in Group II. DASH in patients of Group I was significantly higher than that in patients in Group II and patients of Group I had CMS scores significantly lower than patients in Group II (P<0.05). The rates of varus malunion, screw perforation, and loss of reduction>5mm were significantly higher in Group I than in Group II (P<0.05).
The present results showed that that patients treated by LCP with fibular allograft had a better functional outcome and a lower complication rate compared to patients treated by LCP alone. Suitable void filler in the proximal humerus for supporting the head fragment, medial cortical bone, and greater tuberosity might play a key role in reducing the incidence of the complications in elderly patients, especially with osteoporosis.
本研究旨在比较锁定加压钢板（LCP）与腓骨植骨联合 LCP 治疗老年移位型肱骨近端骨折（PHF）的临床疗效和并发症。
2010 年 1 月至 2013 年 12 月，采用 LCP 或 LCP 联合腓骨植骨治疗老年移位型 PHF 患者 97 例，最终 89 例患者纳入本研究。所有患者分为Ⅰ组（采用 LCP 治疗）和Ⅱ组（采用 LCP 联合腓骨植骨治疗）。采用残疾程度、上肢、手（DASH）评分和 Constant-Murley 评分（CMS）评估功能结果，并记录各组并发症。
Ⅰ组平均随访 35.2 个月（2448 个月），Ⅱ组平均随访 33.5 个月（2448 个月）。Ⅰ组患者的 DASH 评分明显高于Ⅱ组，CMS 评分明显低于Ⅱ组（P<0.05）。Ⅰ组患者发生内翻畸形愈合、螺钉穿出、复位丢失>5mm 的比例明显高于Ⅱ组（P<0.05）。
与单独采用 LCP 治疗相比，LCP 联合腓骨植骨治疗老年 PHF 患者的功能恢复更好，并发症发生率更低。在近端肱骨中合适的骨填充材料以支撑头节、内侧皮质骨和小结节，可能在降低老年患者（尤其是骨质疏松患者）并发症发生率方面发挥关键作用。
