探讨应用Philos钢板联合个体化髓内解剖型骨水泥占位器治疗老年骨质疏松性肱骨近端骨折的可行性及疗效。

回顾性分析从2020年1月至2021年6月在本院治疗的38例老年骨质疏松性肱骨近端骨折患者，按固定方式的不同，分为Philos钢板联合个体化髓内解剖型骨水泥占位器组（A组，n=18）和单独Philos钢板组（B组，n=20），比较两组患者手术时间、术中出血量、术后48 h切口引流量、骨折愈合时间、术后随访影像学资料（颈干角丢失量、肱骨头内翻角度、肱骨头高度丢失量）、肩关节Constant-Murley评分（Constant-Murley scores,CMS）及总并发症发生情况。

所有38例患者术后均获随访,两组患者手术时间、术中出血量、术后48 h切口引流量、骨折愈合时间比较差异无统计学意义（P>0.05），但术后颈干角丢失量、肱骨头内翻角度、肱骨高度丢失量、CMS评分及术后总并发症发生率比较，A组则均优于B组（P<0.05）。

应用Philos钢板联合个体化髓内解剖型骨水泥占位器治疗老年骨质疏松性肱骨近端骨折临床效果优于单独Philos钢板内固定，其具有固定强度高、复位维持好、功能评分高、并发症少等优点，是一种治疗老年骨质疏松性肱骨近端骨折的可靠方法。

Fractures of the proximal humerus account for 5% of all fractures, and the incidence of comminuted fractures of the proximal humerus gradually increases with age, among which 71% of proximal humerus fractures occur in the elderly population over 60 years old. Except for conservative treatment for a small number of patients who cannot tolerate anesthesia, open reduction and internal fixation is still the first choice for treating displaced proximal humeral fractures. Affected by the fragile bone mass, elderly osteoporotic proximal humeral fractures of Neer type III-IV fractures are often accompanied by small fragments of metaphyseal comminuted. Most have metaphyseal compression or defect, which is extremely unstable and needs to be strengthened and rigid internal fixation. Still, due to the thin layer of cortical bone and sparse trabecular bone structure, the anchoring strength between internal fixation and bone is significantly reduced. Currently, the clinical treatment of this type of fracture often uses a single lateral plate fixation. Some scholars have reported that complications with a single locking plate are as high as 50%, and the related revision rate is about 15%. Complications include varus collapse, loss of reduction, screw penetration into the joint, internal fixation failure, subacromial impingement, and necrosis of the humeral head. Most scholars agree that repairing the medial structure, restoring metaphyseal support, and anatomically reducing nodules are the key to ensuring the therapeutic effect. Some studies have suggested that using a lateral plate combined with an allogeneic fibula or autologous ilium for intramedullary support can help resolve metaphyseal osteopenia and provide medical support for patients with osteoporosis, and achieve good clinical results. However, this method of bone implant fixation is limited by the source of the allogeneic bone, increased infection rate, disease transmission, immune rejection, complications in the donor site of autologous bone, etc., and has not been widely used clinically.

To investigate the feasibility and efficacy of PHILOS plate combined with individualized intramedullary anatomical bone cement placeholder in treating elderly osteoporotic proximal humeral fractures.

Retrospective analysis was made on 38 cases of elderly osteoporotic proximal humeral fractures treated in our hospital from January 2020 to June 2021. According to the different fixation methods, they were divided into two groups: the PHILOS plate combined with individualized intramedullary anatomical bone cement placeholder group (group A, 18 cases) and the PHILOS plate alone group (group B, 20 cases) . The operation time, intraoperative blood loss, incision drainage volume 48 hours after the operation, fracture healing time Follow up imaging data (loss amount of neck shaft angle, humeral head varus angle, loss amount of humeral head height) , Constant Murley scores of the shoulder (CMS) and total complications.

All 38 patients were followed up after the operation. There was no significant difference between the two groups regarding the operation time, intraoperative bleeding volume, incision drainage volume 48 hours after the operation, and fracture healing time (P>0.05) . Still, the loss of neck shaft angle, humeral head varus angle, humeral height loss, CMS score, and the incidence of total complications after the operation were better in group A than in group B (P<0.05) .

The clinical effect of PHILOS plate combined with individualized intramedullary anatomical bone cement placeholder in treating elderly osteoporotic proximal humeral fracture is better than that of internal fixation with Philips plate alone. It has the advantages of high fixation strength, sound reduction and maintenance, high functional score, and fewer complications. It is a reliable method for treating an elderly osteoporotic proximal humeral fracture.