肱骨近端锁定钢板和接骨板治疗老年骨质疏松性肱骨近端骨折疗效的比较研究  

A prospective study on effects of PHILOS locking plate on clinical outcomes in elder patients with osteoporosis humeral proximal fractures

作　　者：张磊[1] 张云庆[1] 周正明[1] 周枫[1] 姜雪峰[1] ZHANG Lei;ZHANG Yun-qing;ZHOU Zheng-ming;ZHOU Feng;JIANG Xue-feng(Department of Orthopedics,Jiangyin Hospital,Medical College of Southeast University.Jiangyin,Jiangsu,214400,China)

机构地区：[1]东南大学医学院附属江阴医院骨科

出　　处：《中国骨与关节杂志》2019年第11期856-861,共6页Chinese Journal of Bone and Joint

摘　　要：目的比较肱骨近端锁定钢板(proximal humeral internal locking system,PHILOS)和锁定接骨板(locking proximal humerus plate,LPHP)治疗骨质疏松性肱骨近端骨折的临床疗效。方法本组共纳入82例,采用随机信封法将患者分为观察组(41例)和对照组(41例),其中男34例,女48例。观察组采用PHILOS内固定治疗,其中男16例,女25例,平均年龄为(70.32±6.32)岁;22例为三部分骨折,19例四部分骨折;18例交通事故伤、6例跌倒摔伤、11例高处坠落骨折、砸伤及压伤各3例。对照组采用LPHP内固定进行治疗,其中男18例,女23例,平均年龄为(71.84±6.88)岁;23例三部分骨折,18例四部分骨折;16例交通事故伤、8例跌倒摔伤、12例高处坠落损伤、3例压伤、2例砸伤。记录并分析两组的手术时间、术中失血量及愈合时间;对比两组术前、术后4周的疼痛视觉模拟评分(visual analogue scale,VAS)、不同时间点的Lane-Sandhu评分、术后3个月肩关节活动度及并发症发生情况。结果观察组的手术时间、术中失血量及愈合时间分别为[(66.83±9.16)min,(205.12±26.22)ml和(2.69±0.51)个月],与对照组[(87.14±11.13)min,(258.66±26.12)ml和(3.81±0.72)个月]相比,差异有统计学意义(P=0.000)。两组手术前后的VAS评分及日常生活能力评分相比,差异有统计学意义(P=0.000)。两组术后VAS评分相比,差异有统计学意义(P=0.000)。观察组术后1个月、3个月、7个月及10个月的Lane-Sandhu评分与对照组相比,差异有统计学意义(P=0.025,0.000,0.000,0.000)。观察组术后3个月的关节活动度与对照组相比,差异有统计学意义(P=0.000)。观察组的治愈率为97.6%(40/41),高于对照组80.49%(33/41),与对照组相比差异有统计学意义(P=0.034)。两组的并发症发生率相比,差异无统计学意义(P=0.556)。结论PHILOS较传统LPHP钢板治疗骨质疏松性肱骨近端骨折具有明显优势,可缩短患者术后愈合时间,提高治愈率,提升肩关节活动度及LaneObjective To compare the clinical efficacy of proximal humeral internal locking system(PHILOS)and locking proximal humeral plate(LPHP)in the treatment of osteoporosis proximal humeral fractures.Methods A total of 82 patients with proximal humeral fractures were included in the study.Randomized envelope method was used to divide all patients into observation group and control group with 41 patients in each group.There were 34 males and 48 females.Observation group(16 males,25 females):patients were treated with PHILOS locking plate;the average age was(70.32±6.32)years;22 patients were of three-part fracture;19 patients were of four-part fracture;18 patients were of traffic injury;6 patients were of falling injury;11 patients were of falling from a height;3 patients were of crashing;3 patients were of crushing.Control group(18 males,23 females):patients were treated with LPHP;the average age was(71.84±6.88)years;23 patients were of three-part fracture;18 patients were of four-part fracture;16 patients were of traffic injury;8 patients were of falling injury;12 patients were of falling from a height;3 patients were of crashing;3 patients were of crushing.Intraoperative blood loss,operation time and healing time were recorded and analyzed.Preoperative and 4-week postoperative visual analogue scale(VAS)pain score and daily life ability,Lane-Sandhu scores of different time points,shoulder joint movement 3 months postoperatively and complications were recorded as well.Results Operation time,intraoperative blood loss and healing time in the observation group were(66.83±9.16)min,(205.12±26.22)ml and(2.69±0.51)months,respectively,which were significantly better than those in the control group[(87.14±11.13)min,(258.66±26.12)ml and(3.81±0.72)months].Difference were statistically significant(P=0.000).The VAS pain score and daily living ability score were significantly better than those before operation(P=0.000),and the observation group was significantly better than the control group(P=0.000).The Lane-Sandhu scores of

关 键 词：肩骨折 骨折固定术 内 治疗结果 

分 类 号：R683.4[医药卫生—骨科学]