小切口入路锁定钢板治疗老年肱骨近端骨折的临床疗效观察

目的:探讨小切口入路锁定钢板治疗老年肱骨近端骨折的疗效。方法:选取了80例肱骨近端骨折患者,按随机数字表法分为两组,对照组(39例)给予三角肌入路锁定钢板,观察组(41例)给予小切口入路锁定钢板治疗,通过观察并记录围手术期指标,术前术后3个月的Neer评分,术后24 h的凝血指标,随访3个月期间的并发症发生情况,评价小切口入路锁定钢板治疗老年肱骨近端骨折的疗效。结果:观察组手术、住院、骨折愈合所需时间均短于对照组(P0.05),两组术中出血量相比,无统计学差异(P.05),术前观察组与对照组Neer评分相比,无统计学差异(P0.05),术后3个月,观察组与对照组Neer评分均明显增加,且观察组高于对照组(P0.05)。术前两组凝血指标无明显差异,术后24 h,两组国际标准化比率(International Normalized Ratio,INR)相比无明显变化,血浆凝血酶原时间(prothrombin time,PT),活化部分凝血活酶时间(activated partial thromboplastin time,APTT)均明显降低(P0.05)。对照组血浆纤维蛋白原(Plasma fibrinogen,FIB)水平明显升高,观察组FIB术前术后24 h无明显变化(P0.05),术后24 h,两组患者PT,APTT,INR相比无统计学差异(P0.05)观察组FIB水平明显低于对照组(P0.05)。随访3个月期间,两组均未出现切口感染、血管神经损伤等严重并发症。结论:小切口入路锁定钢板对老年肱骨骨折具有较好的治疗效果,能显著改善患者肩关节功能,对血液系统影响较小,术后并发症少,值得临床推广使用。

Clinical Efficacy of Small Incision Approach Locking Plate in Treatment of Proximal Humeral Fractures in Elderly Patients

ABSTRACT Objective: To discuss the efficacy of small incision approach locking plate in treatment of proximal humeral fractures in elderly patients. Methods: 80 patients with proximal humeral fractures were selected, they were divided into two groups randomly. The control group (39 cases) was given deltoid approach locking plate. The observation group(41 cases) was given small incision approach locking plate. The efficacy of small incision approach locking plate in treatment of proximal humeral fractures in elderly patients was evaluated by perioperative indexes, Neer scores before and after 3 months operation, coagulation indexes after 24 h and complications during 3 months follow-up. Results: The operation time, hospitalization, and fracture healing time of observation group was shorter than that of the control group(P<0.05). There were no statistical significance on Neer scores between two groups(P>0.05). After 3 months operation, the Neer scores were increased (P<0.05). The scores of observation group were higher than that of the control group(P<0.05). Before 24 h operation, there were no statistical significance on PT, APTT, INR, FIB between two groups(P>0.05). After 24 h operation, there were no statistical significance on INR between two groups(P>0.05). The PT and APTT were decreased in two groups(P<0.05). In the control group, the FIB were increased (P<0.05). In the observation group, there were no statistical significance on FIB before and after operation (P>0.05). After 24 h operation, there were no statistical significance on PT, APTT and INR between two groups (P>0.05). The FIB of observation group was lower than that of the control group (P<0.05). During 3 months follow-up, there were no severe incision infection, vascular and nerve injury in two groups (P>0.05). Conclusion: Small incision approach locking plate has a good therapeutic effect on elderly humeral fractures. It can improve the shoulder joint function with less complications and little effect on hematologic system, worthy of clinical application.