Objective To investigate the clinical effect of locking plate fixation in treatment of proximal humeral fractures in the elderly.Methods This retrospective case control study enrolled 96 patients with closed proximal humeral fractures admitted from October 2013 and October 2015.There were 52 males and 44 females,with age of (68.2 ± 1.4) years (range,62-74 years).According to the Neer classification of proximal humeral fractures,two-part fractures were noted in 27 patients,three-part fractures in 57,and four-part fractures in 12.According to the surgical methods,the patients were assigned to locking plate fixation (observation group) and anatomic plate fixation (control group),with 48 cases each.Operation time,intraoperative blood loss,hospitalization time,fracture healing time,varus angle of the humeral head,visual analogue score (VAS),Neer shoulder score for shoulder function and related complications were observed.Results All patients were followed up for 13-24 months (mean,18.5 months).Better results were observed in observation group than control group in aspects of operation time [(51.2 ± 14.8) minutes vs.(73.2 ±27.3)minutes],intraoperative bleeding[(158.3 ±32.9)ml vs.(270.9 ± 34.8) ml],hospitalization time [(8.2 ± 2.9) days vs.(13.1 ± 2.2) days],fracture healing time [(93.7 ±18.4)days vs.(122.9±18.9)days],varus angle of the humeral head [(2.2±1.8)° vs.(4.2± 1.3) °],VAS [(2.0 ± 0.7) points vs.(5.1 ± 1.2) points],excellence rate of Neer score (98％ vs.90％) and postoperative complication incidence (10％ vs.21％) (P ＜ 0.05).Conclusion Compared with the anatomical plate,locking plate fixation has advantages of shorter operation time,less intraoperative bleeding,earlier bone healing,better shoulder movement and less postoperative complications in treatment of proximal humeral fractures.

Objective To assess the effect and safety of tranexamic acid used in spinal surgery by means of a systematic review and Meta-analysis.Methods Literatures were retrieved from Ovid (1999 March to 2017 March),PubMed (1999 March to 2017 March),Sciencedirect(1999 March to 2017 March),CNKI,VIP and Wangfang.All the related literatures were checked on the selection criters.Only the retrospective randomized controlled trails (RCTs) with high quality (Jadad score ≥ 3) and with double-blind process were enrolled.The relevant data were analyzed using RevMan 5.0 to compare about difference of intraoperative and postoperative blood loss,transfusion rate,postoperative activated partial thromboplastin time (APTT),postoperative hematocrit (Hct),postoperative hemoglobin (Hb) and thrombotic complications between tranexamic acid group and placebo group.Results Only 8 high quality RCTs met the inclusion criteria.The use of tranexamic acid in spinal surgery significantly reduced the intraoperative blood loss(SMD =-0.33,95％ CI-0.12,0.54,P ＜0.01),and reduced the rate of transfusion(OR =0.55,95％ CI0.37,0.82,P ＜0.01).TXA group had a significant decrease of APTT at 24 h after surgery(MD =1.45,95％ CI-2.92,0.01,P ＞ 0.05),a significant increase of postoperative Hct (MD =1.55,95％ CI 0.45,2.65,P ＜ 0.01) and an enhancement of Hb (MD =0.49,95％ CI 0.20,2.65,P ＜ 0.01) compared with placebo group.The difference of thrombotic complication rates risks between tranexamic acid group and placebo group was not statistically significant(OR =1.01,95％ CI 0.06,16.52,P ＞ 0.05).Conclusion The use of tranexamic acid can significantly reduce intraoperative blood loss and the rate of transfusion during spinal surgery,without increase of postoperative deep vein thrombosis or pulmonary embolism.