半肩关节置换治疗老年人肱骨近端复杂骨折的疗效分析  

Efficacy of hemiarthroplasty of shoulder on proximal humeral fracture in the elderly patients

作　　者：倪莉[1] 丁庆丰 张志刚[1] 季承[1] 张凯[1] 王晟昊[1] 吴贵忠[1] 杨惠林[1] NI Li;DING Qingfeng;ZHANG Zhigang;JI Cheng;ZHANG Kai;WANG Shenghao;WU Guizhong;YANG Huilin(Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中华骨与关节外科杂志》2018年第12期910-913,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:老年患者肱骨近端复杂骨折的手术方案选择存在着一定争议。目的:探讨Bigliani/Flatow半肩关节置换治疗老年人肱骨近端骨折的疗效。方法:回顾性分析自2012年10月至2016年6月,我科采用BF半肩关节置换治疗的老年人肱骨近端复杂骨折25例,其中男9例,女16例,年龄60~89岁,平均(71.3±8.6)岁。骨折按Neer分型:3部分骨折6例,3部分骨折伴脱位4例,4部分骨折12例,4部分骨折伴脱位3例。同期采用切开复位肱骨近端解剖型锁定接骨板固定治疗老年肱骨近端复杂骨折22例,其中男13例,女9例。年龄62~75岁,平均(67.4±5.3)岁。骨折分型为3部分骨折12例,3部分骨折伴脱位5例,4部分骨折4例,4部分骨折伴脱位1例。分别对两组患者的手术时间,术中出血量,术后临床功能,术后并发症进行对比分析。结果:所有患者均获得随访,随访时间15~55个月,平均(27.8±14.2)个月。置换组手术时间65~150min,平均(95.5±26.3) min,内固定组95~210min,平均(127.2±38.4)min;置换组术中出血量平均(237.4±68.5)ml,内固定组平均(315.3±95.4)ml。按美国肩肘外科评分标准进行临床疗效评定,置换组优12例,良6例,中4例,差3例;内固定组优8例,良6例,中4例,差4例。置换组出现锁骨下静脉血栓1例,内固定组出现内固定松动3例,肱骨头坏死1例。结论:BF半肩关节置换术是治疗老年人肱骨近端复杂骨折的有效方法之一,把握严格的手术适应证,围术期的精心准备,规范的手术操作是取得良好疗效的关键。Background: There are some controversies about the choice of surgical treatment for the elder patients with proxi-mal humeral fractures. Objective: To explore the effect of hemiarthroplasty of shoulder in elder patients with proximal humeral fractures. Methods: From October 2012 to June 2016, 25 elder patients with proximal humeral fractures received hemiarthro-plasty of shoulder including 9 males and 16 females, aged 60-89 years with the average of (71.3±8.6) years. According to Neer classification, there were 6 patients with fracture of 3 parts, 4 patients with fracture of 3 parts and dislocation, 12 patients with fracture of 4 parts, and 3 patients with fracture of 4 parts and dislocation. Meanwhile, 22 patients who suffered the proximal hu-meral fractures received open reduction and internal fixation with philos including 13 males and 9 females aged 62-75 years with the average of (67.4±5.3) years old. According to Neer classification, there were 12 patients with fracture of 3 parts, 5 pa-tients with fracture of 3 parts and dislocation, 4 patients with fracture of 4 parts, and 1 patients with fracture of 4 parts and dis-location. The operation time, blood loss, postoperative clinical function and complications were compared between the two groups. Results: All patients were followed up for 15 to 55 months with the mean as (27.8±14.2) months. The operation time was (95.5±26.3) minutes ranged 65-150 minutes in the BF group and (127.2±38.4) minutes ranged 95-210 minutes in the Phi-los group. The intraoperative blood loss was (237.4±68.5) ml and (315.3±95.4) ml in the BF group and Philos group, respective-ly. According to the ASES score, there were 12 good, 6 fine, 4 moderate, 3 bad in BF group;there were 8 good, 6 fine, 4 moder-ate, 4 bad in the Philos group. One female patient suffered the vein thrombus. 3 patients had internal fixation loosening and 1 patient had caput humeri necrosis in the Philos group. Conclusions: Hemiarthroplasty of shoulder is an effective treatment for the proximal humeral fractu

关 键 词：肱骨近端复杂骨折 半肩关节置换 老年人 内固定 

分 类 号：R687.3[医药卫生—骨科学]