杨树龙++李永胜

[摘要] 目的 探讨锁定钢板结合注射式磷酸钙骨水泥治疗老年肱骨近端骨折的临床疗效。方法 采用锁定钢板结合可注射式磷酸钙骨水泥（CPC）对该院从2014 年8 月—2016 年5月收治的22 例老年肱骨近端NeerⅢ、Ⅳ型骨折患者进行治疗。结果 22例患者术后均获得10～18个月（平均15.6个月）随访，所有患者骨折均獲得骨性愈合，愈合时间10～16周，平均12.7周，术后无感染及内固定松动发生，根据Neer评分评定，显效15 例，有效4例，无效3例，总有效率为86.4%。结论 注射式磷酸钙骨水泥具有安全、方便、不良反应小、填充骨缺损，尤其可强化锁定螺钉在肱骨近端的把持力，从而增强锁定钢板固定骨质疏松患者肱骨近端骨折的稳定性，临床疗效满意。

[关键词] 骨质疏松；锁定钢板；磷酸钙类；肱骨近端骨折

[中图分类号] R687 [文献标识码] A [文章编号] 1674-0742（2017）05（b）-0008-03

[Abstract] Objective To study the clinical curative effect of locking plate and calcium phosphate cement in treatment of senile proximal humerus NeerⅢand Ⅳtype fractures. Methods 22 cases of senile patients with proximal humerus NeerⅢand Ⅳtype fractures admitted and treated in our hospital from August 2014 to May 2016 were selected and treated with locking plate and calcium phosphate cement. Results 22 cases were followed up for 10 months to 18 months， 15.6 months on average after operation， and all fractures of patients were cured， and the healing time was between 10 weeks and 16 weeks， 12.7 weeks on average， and there was no infection or internal fixation after operation， and according to the Neer score， 15 cases were markedly effective， 4 cases were effective and 3 cases were ineffective， and the total effective rate was 86.4%. Conclusion The CPC is safe and convenient with few side effect， which can fill the bone defect， especially can intensify the grip force of lock screw in the proximal humerus thus enhancing the stability of locking plate in fixing the fractures of the proximal humerus of osteoporosis patients， and the clinical curative effect is satisfactory.

[Key words] Osteoporosis； Locking plate； Calcium phosphates； Fractures of the proximal humerus

在临床上肱骨近端骨折是比较常见的骨折，在该类骨折中，60岁以上患者占70%，近30年内该年龄段发病率增长近3倍[1]。骨折后患者疼痛、功能障碍影响正常生活，严重者可致残，给患者及家属带来了巨大的精神及经济负担。老年人多伴有骨质疏松，骨折复位后常伴有明显的骨质缺损，为了使患侧肩关节早期功能锻炼，为避免术后内固定松动、脱落和骨折延迟愈合及畸形愈合，为对骨折复位后提供有效力学支撑。从2014 年8 月—2016 年5月该科对22 例肱骨近端骨折老年患者均使用可注射式磷酸钙骨水泥（Calcium phosphate Cement ，CPC）注入预植入肱骨近端锁定螺钉的钉道内，填充局部骨缺损，同时增强肱骨头内锁定螺钉的把持力为锁定钢板固定肱骨近端骨折获得了满意的临床疗效，现报道如下。……