Objective:To evaluate anatomical locking plate combined with bone cement intramedullary support in the treatment of proximal humeral fractures in the elderly.Methods:From May 2016 to July 2018, 19 geriatric proximal humeral fractures were treated with anatomical locking plate combined with bone cement intramedullary support at Department of Orthopaedics, General Hospital of Shenyang Northern Theater. There were 8 females and 5 males, with an average age of 71 years (from 60 to 84 years). All the fractures were closed. According to the Neer classification, there were 4 two-part, 5 three-part and 4 four-part fractures. At 6, 12, 18 and 36 weeks and one year postoperatively, anteroposterior and lateral X-ray films of the scapula were taken. At the last follow-up, the Constant-Murley shoulder score and the Disabilities of the Arm, Shoulder and Hand (DASH) score for the upper limb dysfunction were recorded.Results:The 13 patients were followed up for 3 to 12 months (6 months on average). Bony union was achieved in all the 13 patients. Local necrosis and deformation of the humeral head and partial screw perforation were observed one year after operation in 2 cases, but other patients reported no such complications or loosening of internal fixation. At the last follow-up, their mean Constant-Murley score was 82.6 (from 71 to 95) and their mean ADSH score 19.2 (from 9.2 to 48.1).Conclusion:Anatomical locking plate combined with bone cement intramedullary support may lead to fine early efficacy for the treatment of proximal humeral fractures in the elderly, since it can facilitate fracture reduction, promote rigid fixation and prevent loss of reduction.

ABSTRACT OBJECTIVE：To investigate the quality differences of Pinelliae Rhizoma with different diameter，and to providereference for the rational utilization of its resources. METHODS：A total of 65 batches of commercial Pinelliae Rhizoma from thefour major medicinal markets in China and two companies were collected as samples，the diameter of them were measured byvernier caliper，and then them were screened into samples with different diameter ranges（0.5 cm≤d≤0.8 cm，0.8 cm＜d≤1.0cm，1.0 cm＜d≤1.2 cm，1.2 cm＜d≤1.5 cm，1.5 cm＜d≤2.0 cm）by sieving. The content of organic acids（oxalic acid，citricacid，L-malic acid，succinic acid，fumaric acid，trans-aconitic acid and cis-aconitic acid）in Pinelliae Rhizoma samples of differentdiameter ranges were determined by HPLC，and the content of the extracts of Pinelliae Rhizoma samples of different diameterranges were determined by cold leaching method according to 2201 general principles in 2015 edition of Chinese Pharmacopoeia（Part Ⅳ），to evaluate the quality difference of Pinelliae Rhizoma in different diameter ranges.73 batches of Pinelliae Rhizoma fromcorresponding 10 main producing areas were collected as samples，to investigate its distribution of diameter. RESULTS：Dtermination of 65 batches of commercial Pinelliae Rhizoma showed that the content of organic acids and extracts in PinelliaeRhizoma increased with the increase of its diameter in general. However，there were no significant difference in organic acids andcontent of the extracts among Pinelliae Rhizoma samples of different diameter ranges in the same batch（P＞0.05）. The diameter distribution of 73 batches of Pinelliae Rhizoma from corresponding areas was mainly between 0.6 cm and 1.8 cm，with an averageweight of 95.54％. If the diameter standard（1-1.5 cm）specified in the 2015 edition of Chinese Pharmacopoeia（part Ⅰ）wasadopted，only 8 of 73 batches of Pinelliae Rhizoma meet the requirements，and the qualified rate was 10.96％；if the diameterrange was properly expanded to 0.7-1.5 cm，54 batches of Pinelliae Rhizoma meet the requirements，with a qualified rate of73.97％；when the diameter range was expanded to 0.7-1.6 cm，68 batches of Pinelliae Rhizoma meet the requirements，with aqualified rate of 93.15％ .CONCLUSIONS：There is no significant difference in the quality of Pinelliae Rhizoma with different diameters. Combined with the diameter distribution of Pinellia Rhizoma in different producing areas，the diameter range of 1-1.5cm specified in relative standard can be expanded to 0.7-1.6 cm，avoiding the waste of resources.