探讨锁定钢板结合异体腓骨治疗老年肱骨近端Neer III、IV型骨折的临床疗效。

回顾性分析2014年1月至2019年10月本院56例肱骨近端Neer III、IV型骨折患者资料，其中采用单纯锁定钢板治疗31例患者为A组，锁定钢板结合异体腓骨治疗25例患者为B组。采用Constant-Murley肩关节功能评分和肩关节活动范围（range of motion，ROM）对患者的肢体功能进行评定，并评估治疗效果及并发症发生情况。

两组患者基本资料的差异均无统计学意义（P>0.05）。术后Constant-Murley评分，A组（62.89±8.25）分，B组（75.42±4.77）分，差异有统计学意义（P<0.05）；术后ROM评分，A组（18.34±4.43）分，B组（25.77±3.84）分，差异有统计学意义（P<0.05）。A组中1例发生肱骨头内翻畸形，2例发生螺钉切出，1例发生肱骨头坏死，并发症发生率为12.9%；B组中1例发生伤口感染，1例发生肱骨头坏死，并发症发生率为8.0%，低于A组，差异有统计学意义（P<0.05）。

锁定钢板结合异体腓骨治疗老年肱骨近端Neer III、IV型骨折，疗效优于单纯锁定钢板治疗，能对肱骨头提供有效支撑及稳定性，使患者术后顺利进行早期功能锻炼，提高患者术后生活质量。

Proximal humeral fractures account for 4%-5% of total fractures, in which elderly patients account for 70%, and the incidence is still increasing year by year. Locking compression plate is a common method for treatment of proximal humeral fractures, and the clinical effect is definite. However, the postoperative complication rate is very high, among which the incidence of varus deformity is as high as 71%. In recent years, fibula allograft combined with locking plate has gradually become popular in the treatment of proximal humeral fractures.

To investigate the clinical efficacy of locking compression plate combined with fibula allograft in the treatment of senile proximal humeral fractures of Neer part-III and IV.

From January 2014 to October 2019, the data of 56 patients with Neer part-III and IV proximal humeral fractures in our hospital were retrospectively analyzed. Among them, 31 cases treated with locking compression plate were divided into group A, and 25 cases treated with locking compression plate and fibula allograft were divided into group B. The Constant-Murley and ROM scores of shoulder joint function were used to evaluate the patient's limb function, the treatment effect and the occurrence of complications.

There was no statistically significant difference between the two groups of basic data (P>0.05) . The postoperative Constant-Murley scores were (62.89±8.25) points in group A and (75.42±4.77) points in group B, and the difference was statistically significant (P<0.05) . The postoperative ROM scores were (18.34±4.43) points in group A and (25.77±3.84) points in group B, and the difference was statistically significant (P<0.05) . In group A, there were 1 case of humeral head varus deformity, 2 cases of screw excision and 1 case of humeral head necrosis, and the complication rate was 12.9%. In group B, there were 1 case of wound infection and 1 case of humeral head necrosis, and the complication rate was 8.0%, which was lower than that of group A with statistical difference (P<0.05) .

Locking compression plate combined with fibula allograft in the treatment of elderly proximal humeral fracture of Neer type-III and IV is better than those with simple locking compression plate. It can provide sufficient support and stability to the humeral head, so that patients can carry out early functional exercise smoothly after surgery, and improve the quality of life of patients after surgery.