CAJ | 학술논문

目的：比较肱骨近端锁定钢板（LPHP）内固定与保守疗法对老年肱骨近端Neer 3型骨折的治疗效果。方法回顾性分析广东云浮市人民医院收治的50例老年肱骨近端Neer 3型骨折患者的临床资料，其中LPHP内固定组患者（n=22）行LPHP内固定，保守治疗组患者（n=28）采用闭合复位、石膏固定。记录两组住院时间、住院费用及骨折愈合时间，观察术后并发症发生情况，依照Neer评分系统对患者术后6个月肩关节功能进行评估。结果所有患者获得6～26个月（平均14.5个月）随访。LPHP内固定组住院时间较保守治疗组长，住院费用多于保守治疗组；术后6个月Neer肩关节评分优良率优于保守治疗组。两组比较，差异有统计学意义（P＜0.05）。两组均未有褥疮、坠积性肺炎、肱骨头缺血性坏死等并发症出现。保守治疗组并发症发生率（54%）明显高于LPHP内固定组（18%），两组比较，差异有统计学意义（P ＜0.05）。结论与保守治疗比较， LPHP内固定具有固定可靠、肩关节功能恢复好、并发症少等特点，是治疗老年肱骨近端Neer 3型骨折的较好选择。
목적：비교굉골근단쇄정강판（LPHP）내고정여보수요법대노년굉골근단Neer 3형골절적치료효과。방법회고성분석엄동운부시인민의원수치적50례노년굉골근단Neer 3형골절환자적림상자료，기중LPHP내고정조환자（n=22）행LPHP내고정，보수치료조환자（n=28）채용폐합복위、석고고정。기록량조주원시간、주원비용급골절유합시간，관찰술후병발증발생정황，의조Neer평분계통대환자술후6개월견관절공능진행평고。결과소유환자획득6～26개월（평균14.5개월）수방。LPHP내고정조주원시간교보수치료조장，주원비용다우보수치료조；술후6개월Neer견관절평분우량솔우우보수치료조。량조비교，차이유통계학의의（P＜0.05）。량조균미유욕창、추적성폐염、굉골두결혈성배사등병발증출현。보수치료조병발증발생솔（54%）명현고우LPHP내고정조（18%），량조비교，차이유통계학의의（P ＜0.05）。결론여보수치료비교， LPHP내고정구유고정가고、견관절공능회복호、병발증소등특점，시치료노년굉골근단Neer 3형골절적교호선택。
Objective To compare the therapeutic effects between locking proximal humerus plate (LPHP) internal fixation and conservation treatment for Neer type 3 proximal humeral fracture in elderly. Methods Clinical data of 50 elderly patients with Neer type 3 proximal humeral fractures treated in Yunfu People's Hospital were retrospectively analyzed. The patients were divided into LPHP group (n = 22, receiving LPHP internal fixation) and conservation group (n = 28, receiving close reduction and plaster fixation). Hospital stay, cost of hospitalization and fracture healing time in two groups were recorded, postoperative complications were <br> observed, shoulder functions were evaluated according to Neer scoring system at six months after the surgery. Results All patients were followed up for 6-26 months with the average of 14.5 months. In LPHP internal fixation group, length of hospital stay was longer, and cost of hospitalization was higher compared with conservation group; At 6 months postoperatively, Neer excellent and good rate was better than that in conservation group. There were statistical differences between two groups (P <0.05). No complications of decubitus, hypostatic pneumonia or ischemic necrosis of humeral head were found. Complication incidence in LPHP group was 18% while in conservation group was 54%, the differences had statistical significance (P <0.05). Conclusions LPHP internal fixation is a good choice for elderly patients with Neer type 3 proximal humeral fracture, which could provide stable fixation, good shoulder rehabilitation and less complications compared with conservation group.