Objective To compare proximal humeral internal locking system (PHILOS) combined with fibular strut allograft versus simple PHILOS for the treatment of Neer 3-and 4-part factures of proximal humerus in the elderly.Methods A retrospective study was conducted of 157 elderly patients with Neer 3-or 4-part facture of proximal humerus who had been treated at Department of Orthopaedics,Ningbo No.6 Hospital from May 2013 to October 2016.They were 76 males and 81 females,aged from 60 to 88 years (average,76.1 years).According to the Neer classification,100 cases were 3-part fractures and 57 4-part fractures.Of them,35 were treated by PHILOS combined with fibular strut allograft (group A) and 122 by PHILOS alone (group B).At the last follow-up,the 2 groups were compared in terms of shoulder joint activity (anteflexion,abduction,internal rotation and external rotation),visual analogue scale (VAS),American Shoulder and Elbow Surgeons (ASES) score,Constant-Murley score,postoperative height loss of the humeral head,humeral head varus angle,complication rate and secondary surgery rate.Results The 157 patients were followed up for 12 to 22 months (mean,16.8 months).The fracture healing time was 13.0 ± 3.8 weeks in group A and 15.6 ± 4.2 weeks in group B,showing a statistically significant difference (P ＜ 0.05).At the last follow-up,for groups A and B respectively,anteflexion was 135.6° ± 17.7° versus 125.4° ± 23.6°,abduction 132.5°±22.7° versus 117.5°±32.7°,external rotation 30.2°± 18.7° versus 21.6°± 17.2°,internal rotation T9 versus T11,VAS score 0.6 ±0.9 points versus 0.9 ± 1.2 points,ASES score 90.2 ±6.8 points versus 82.2 ± 12.3 points,Constant-Murley score 88.5 ±3.6 points versus 72 ±4.9 points,postoperative height loss of the humeral head 0.9 ± 0.1 mm versus 4.2 ± 0.4 mm,and humeral head varus angle 1.2° ± 0.2° versus 4.5° ± 1.9°.The differences between the 2 groups were all statistically significant (P ＜ 0.05).There were no significant differences between the 2 groups in complication rate [14.28％ (5/35) versus 22.13％ (27/122)] or in secondary operation rate[2.85％ (1/35) versus 8.19％ (27/122)] (P ＞ 0.05).Conclusions In the treatment of Neer 3-and 4-part factures of proximal humerus in the elderly,PHILOS combined with fibular strut allograft can improve therapeutic efficacy,because it can provide good support for the medial column of the proximal humerus and the humeral head and thus facilitate the intraoperative reduction of the fracture.

In China, the aging of the population is becoming increasingly serious. Common diseases of the elderly, such as sarcopenia and metabolic syndrome, have gradually become key factors affecting their quality of life. Sarcopenia is a decline in skeletal muscle mass and function associated with aging. Metabolic diseases such as obesity, hypertension and diabetes play an important role in the development of sarcopenia. In recent years, the relationship between sarcopenia and metabolic syndrome has also become a research hotspot, but there is still a lack of strong evidence on whether they are a risk factor for each other. This paper summarizes the epidemiological data of the relationship between sarcopenia and metabolic syndrome in the last 5 years, and reviews the epidemiological background, research status and potential links in biological mechanism of sarcopenia and metabolic syndrome. There is a significant correlation between sarcopenia and metabolic syndrome that may share similar biological mechanisms. However, there are still some limitations in this study. In addition, the methods of early screening and diagnosis of sarcopenia should be continuously explored to achieve the purpose of simplicity, rapidity and efficiency. This review aims to raise the population's awareness of chronic syndromes sarcopenia and metabolic syndrome, and to provide theoretical support for further research on their relevance.