锁定钢板与人工关节置换术治疗老年人肱骨近端粉碎性骨折的疗效观察  

Clinical efficacy of locking plate versus artificial joint replacement for the treatment of comminuted proximal humeral fractures in the elderly

作　　者：陈忠义[1] 朱萍[1] 冯兴兵[1] 周晓波[1] 

机构地区：[1]浙江省台州医院骨科,临海317000

出　　处：《中华老年医学杂志》2013年第12期1331-1333,共3页Chinese Journal of Geriatrics

摘　　要：目的比较分析锁定钢板与人工关节置换术治疗老年人肱骨近端粉碎性骨折的疗效。方法回顾性分析我院骨科2013年2月至2013年7月采用锁定钢板与人工关节置换术治疗肱骨近端粉碎性骨折患者200例，根据治疗方法不同将其分成锁定钢板组114例和人工关节置换组86例，比较两组患者术后疼痛、功能恢复、活动度、解剖位置、并发症和术后Neer评价结果。结果根据Neer评分标准，人工关节置换组评分优34例、良23例、中25例、差4例，优良率66．3％（57／86）；锁定钢板组评分优53例、良47例、中10例、差4例，优良率87．7％（100／114），锁定钢板组优良率明显高于人工关节置换组（x2=13．35，P〈0．001）。锁定钢板组患者疼痛评分（26．9±8．5）分、功能恢复评分（22．4±7．1）分、活动度评分（19．8士5．5）分和解剖位置评分（8．0±1．8）分；人工关节置换组患者疼痛评分（24．8±10．2）分、功能恢复评分（20．2±6．7）分、活动度评分（18．1±6．6）分和解剖位置评分（7．9士2．1）分，锁定钢板组术后功能恢复和活动度评分明显高于人工关节置换组（￡一2．22、1．99，P一0．014、0．024），而疼痛和解剖位置评分两组患者差异无统计学意义（t=1．59、0．36，P=0．057、0．359）。锁定钢板组患者术后出现关节僵硬2例、骨折畸形愈合1例、肱骨头坏死1例，人工关节置换组患者术后出现关节僵硬1例、伤口感染1例、术后再骨折1例、肱骨头坏死1例，两组患者并发症比较差异无统计学意义（x2=0．17，P=0．683）。结论锁定钢板和人工关节置换术均为治疗肱骨近端粉碎性骨折有效手段，与人工关节置换术比较，锁定钢板手术技术要求较低，可提高术后功能恢复和活动度及改善Neer评价结果，是治疗肱骨近端粉碎性骨折较理想方法。Objective To compare and analyze the clinical efficacy of locking plates versus artificial joint replacement for proximal humeral complicated fractures. Methods The retrospective data of 200 cases with locking plate or artificial joint replacement for the treatment of comminuted proximal humeral fractures were collected from February 2013 to July in our hospital. Patients were divided into locking plate group （n =114） and artificial joint replacement group （n = 86） according to the treatment. The pain, functional recovery, activity, anatomical position, complications and Neer score after treatment were compared between the two groups. Results In artificial joint replacement group, Neer score was excellent in 34 cases, good in 23 cases, fair in 25 cases, poor in 4 cases, and the excellent and good rate was 66.3%（57/86）. In locking plate group, Neer score was excellent in 53 cases, good in 47 cases, fair in 10 cases, poor in 4 cases, and the excellent and good rate was 87.7% （100/114）. The excellent and good rate was higher in locking plate group than in artificial joint replacement group （Z2 = 13.35 ,P=0. 001）. The scores of pain, functional recovery, activity and anatomical position were （26.9±8.5）, （22.4±7.1）, （19.8±5.5） and （8.0±1.8） respectively in locking plate group, and （24.8±10.2）, （20.2±6.7）, （18.1±6.6） and （7.9±2.1） respectively in artificial joint replacement group. There were significant differences in scores of functional recoveryand activity between groups （t = 2.22 and 1.99, P ~ 0. 014 and 0. 024）, while no significant differences were found in scores of pain and anatomical position （t= 1.59 and 0.36, P--0. 057 and 0. 359）. There were 2 cases with ankylosis, 1 case with malunion and 1 case with humeral head necrosis in locking plate group, and 1 case with ankylosis, 1 case with wound infection, 1 case with refracture and 1 case with humeral head necrosis in artificial joint replacement group after treatment. There were no significan

关 键 词：肩骨折 人工关节 

分 类 号：R687.3[医药卫生—骨科学]