2种不同方法治疗复杂肱骨近端骨折的临床观察  

A comparative study of two surgical methods for complex proximal humerus fracture

作　　者：周平[1] 庞飞[1] 陶志昂[1] 

机构地区：[1]绍兴市人民医院手外科,浙江绍兴312000

出　　处：《中华全科医学》2016年第6期973-975,共3页Chinese Journal of General Practice

摘　　要：目的研究人工肩关节置换术(artificial shoulder joint replacement,ASJR)和锁定钢板内固定术(LPHP)对肱骨近端骨折(proximal humeral fractures,PHF)的临床效果和并发症分析,为临床治疗提供参考依据。方法连续选择2012年6月—2015年6月入院首次诊断为PHF的患者共96例,根据治疗方式分为2组,对照组45例选择LPHP,观察组51例选择ASJR,对比临床效果和并发症发生情况。结果 2组的手术时间、出血量和并发症发生率相比,差异均不具有统计学意义(P>0.05)。观察组的Neer功能评价总有效率高于对照组,差异有统计学意义(70.6%vs.48.9%,P<0.05);观察组的肩关节前屈、后伸、外展、内收、外旋、内旋角度明显大于对照组,差异均有统计学意义[(96.2±4.3)°vs.(93.4±4.0)°,(38.4±5.0)°vs.(35.6±4.5)°,(90.5±4.6)°vs.(87.4±4.1)°,(34.4±2.2)°vs.(32.6±2.3)°,(33.0±2.4)°vs.(31.8±2.3)°,(56.6±8.2)°vs.(50.9±8.0)°,P均<0.05]。观察组的远期并发症(肩关节炎、废用性萎缩和再发骨折)发生率小于对照组,差异有统计学意义(7.8%vs.22.2%,P<0.05)。结论 ASJR治疗复杂PHF可明显改善关节功能,且有效减少了术后并发症。Objective To compare the curative effect of artificial shoulder joint replacement（ ASJR） and locking proximal humerus plate（ LPHP） in the treatment of complex proximal humerus fracture（ PHF）. Methods A total of 96 cases of consecutive complex proximal humerus fracture were enrolled into this study,45 of them with LPHP were selected as the control group and other 51 patients with ASJR were selected as the observation group,the effects and complications were compared between the two groups. Results The operation time,blood loss and incidence of complications in the perioperative period were no statistical difference between the two group（ P 〉 0. 05）. The total efficacy rate by Neer score in the observation group was statistically more than that in the control group（ 70. 6% vs. 48. 9%,P 〈 0. 05）,while there was no statistical difference by the hierarchical data comparison（ P 〉 0. 05）. The flexion,extension,adduction,abduction,external rotation,internal rotation angle of shoulder were all statistically larger [（ 96. 2 ± 4. 3） ° vs.（ 93. 4 ± 4. 0） °,（ 38. 4 ±5. 0） ° vs.（ 35. 6 ± 4. 5） °,（ 90. 5 ± 4. 6） ° vs.（ 87. 4 ± 4. 1） °,（ 34. 4 ± 2. 2） ° vs.（ 32. 6 ± 2. 3） °,（ 33. 0 ± 2. 4） ° vs.（ 31. 8 ± 2. 3） °,（ 56. 6 ± 8. 2） ° vs.（ 50. 9 ± 8. 0） °,respectively,P 〈 0. 05]. The incidence of late complications including joint inflammation and atrophy and refracture was statistically lower（ 7. 8% vs. 22. 2%,P 〈 0. 05）. Conclusion The artificial shoulder joint replacement for complex proximal humerus fracture can obviously improve the function of shoulder joint and decrease the incidence of postoperative complications.

关 键 词：人工肩关节置换术 肱骨近端骨折 并发症 锁定钢板内固定 骨水泥 

分 类 号：R683.41[医药卫生—骨科学] R687.4[医药卫生—外科学]