老年肱骨近端骨折患者的锁定加压钢板内固定与人工肱骨头置换疗效对比分析  

Comparison of locking plate and hemiarthroplasty for three and four-part proximal humeral fractures in the elderly

作　　者：谢晓涛[1] 周军杰[1] 吕顺[1] 高文武[1] 陈贤奇[1] 刘铖祎[1] 张磊[1] XIE Xiao-tao ZHOU Jun-jie LU Shun GAO Wen-wu CHEN Xian-qi LIU Cheng-yi ZHANG Lei.(Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Putuo, Shanghai, 200062, PR)

机构地区：[1]上海中医药大学附属普陀医院骨科,200062

出　　处：《中国骨与关节杂志》2016年第9期647-652,共6页Chinese Journal of Bone and Joint

摘　　要：目的对比分析锁定加压钢板内固定与人工肱骨头置换治疗老年三部分与四部分肱骨近端骨折临床疗效。方法回顾性分析2011年10月至2014年10月,我院收治60例肱骨近端粉碎性骨折患者的临床资料,锁定钢板(LCP)内固定术组29例,人工肱骨头置换术(HHR)组31例。记录并比较两组患者术后Constant评分、Neer评分、VAS疼痛评分以及并发症情况。结果末次随访Constant平均总分,LCP组:(74.7±14.1)分,HHR组:(81.6±8.67)分;LCP组:优良率为62.07%,HHR组:优良率为70.97%,两组差异无统计学意义(P>0.05)。Neer平均总分,LCP组:(80.0±11.8)分,HHR组:(83.8±9.0)分,两组差异无统计学意义(P>0.05)。术后3周、3个月及1年VAS评分,LCP组:(4.30±1.54)分、(4.10±1.44)分、(3.92±1.47)分,HHR组:(3.50±1.43)分、(3.10±1.29)分、(2.85±1.26)分,3次VAS疼痛评分差异有统计学意义(P<0.05),HHR组术后缓解肩部疼痛效果优于LCP组。两组病例在手术时间、出血量、住院天数及并发症比较中P>0.05,差异无统计学意义。结论对于老年三部分与四部分肱骨近端骨折LCP内固定与人工肱骨头置换都是有效的治疗手段,两者疗效相似。最终选择何种治疗方案要根据患者的身体状况、肱骨近端血运破坏程度、骨质情况以及手术医生的经验等。Objective To directly compare the locking compression plate and hemiarthroplasty for three and four-part proximal humeral fractures in the elderly. Methods The records of 60 consecutive patients who were 60 years of age or older and in whom a Neer three or four-part proximal humeral fracture had been treated surgically between October 2011 and October 2014; 29 patients treated with a locking compression plate were compared with 31 patients who had undergone hemiarthroplasty. Outcome measurements included Constant and Neer scores, evaluation of local pain at the fracture site and complications. Results Both of the mean Constant score at the time of final follow-up between locking compression plate and hemiarthroplasty were satisfactory. There was no significant difference between LCP group（ 74.7 ± 14.1） points and HHR group（ 81.6 ± 8.67） points（ P〉0.05）. The LCP group had an excellent outcome rate of 62.07%. The HHR group had an excellent outcome rate of 70.97%. There was no significant difference between the treatment outcomes of the mean Constant score（ P〉0.05）. The mean Neer score of LCP group（ 80.0 ± 11.8） points and HHR group（ 83.8 ± 9.0） points had no significant difference（ P〉0.05）. The VAS score at the time of three weeks, three months and one year between two groups showed a better effect with hemiarthroplasty. The scores of LCP group were（ 4.30 ± 1.54） points,（ 4.10 ± 1.44） points and（ 3.92 ± 1.47） points. The scores of HHR group were（ 3.50 ± 1.43） points,（ 3.10 ± 1.29） points,（ 2.85 ± 1.26） points. Two groups of cases had no significant difference in operation time, blood loss, hospitalization days and complications. ConclusionsLocking compression plate and hemiarthroplasty can be considered as useful implants for three and four-part proximal humeral fractures in the elderly. The ultimate choice of treatment should be made according to the patient＇s physical condition, blood supply and patients＇ bone quality and surgical techniques

关 键 词：肱骨骨折 骨折固定术 内 肩骨折 肩关节 肱骨头 肩假体 

分 类 号：R687.32[医药卫生—骨科学]