探讨内侧柱植骨结合PHILOS钢板内固定治疗老年肱骨近端内收型骨折的治疗效果。

对2013年8月至2016年12月舟山顾鹤传骨伤医院创伤关节科治疗的26例老年肱骨近端内收型骨折患者进行回顾性分析，其中男性11例，女性15例；年龄61～89岁，平均(75±14)岁。均因外伤至肩部疼痛入院，X线片示肱骨近端骨折。其中植骨组14例，未植骨组12例。14例植骨组采用内侧柱植骨结合PHILOS钢板内固定治疗，12例未植骨，单纯使用PHILOS钢板内固定治疗。术后定期门诊复查并摄X线片，通过肩关节功能Constant-Murley评分、手术时间、骨性愈合时间以及骨性愈合时颈干角丢失角度等相关指标综合判断治疗效果。

所有患者末次随访时骨折均骨性愈合，植骨组肩关节功能Constant-Murley评分优良率高于未植骨组[13(92.86%) vs 9(75%)，P<0.05]、植骨组骨性愈合时间短于未植骨组[(10.05±3.04) vs (13.03±2.85)，P<0.05]、植骨组骨性愈合时颈干角丢失角度低于未植骨组[(5.12±4.51) vs (11.63±7.04)，P<0.05]，差异有统计学意义(P<0.05)。两组手术时间差异无统计学意义(P>0.05)。

相对于不植骨，内侧柱植骨结合PHILOS钢板治疗老年肱骨近端内收型骨折可取得更满意的临床疗效。

To investigate the therapeutic effect of medial column bone graft combined with PHILOS plate internal fixation for the treatment of proximal humeral adductal fractures in the elderly.

The clinical data of 26 elderly patients with proximal humeral adductal fractures treated by the Department of Traumatology, Zhoushan Guhechuan Hospital from August 2013 to December 2016 were retrospectively analyzed. There were 11 males and 15 females, aged 61-89 years, with an average age of 75±14 years. All patients were admitted to the hospital from trauma to shoulder pain. And CR showed a proximal humerus fracture. 14 cases were treated with medial column bone graft combined with PHILOS plate internal fixation. The cases were not bone grafted, and the PHILOS plate internal fixation was used alone. The postoperative regular outpatient review and X-ray films were performed. The shoulder-joint function Constant-Murley score, operation time, bone healing time and neck dry angle loss angle during bone healing were observed. And other related indicators were used to comprehensively judge the treatment effect.

Bone healing was observed in all patients at the last follow-up. The excellent and good rate of Constant-Murley score of shoulder joint function in bone graft group was higher than that in non-bone graft group [13 (92.86%) vs 9 (75%), P<0.05], the time of bone healing in bone graft group was shorter than that in non-bone graft group [(10.05<3.04) vs (13.03<2.85), P<0.05], and the angle of neck and shaft angle loss in bone graft group was lower than that in non-bone graft group [(5.12<4.51) vs (11.63 + 7.04), P<0.05], the difference was statistically significant (P<0.05). There was no significant difference in operation time between the two groups (P>0.05).

Compared with non-bone grafting, medial column bone graft combined with PHILOS plate for the treatment of senile proximal humeral adductal fracture can achieve more satisfactory clinical results.