保守治疗、钢板固定与人工肱骨头置换治疗老年肱骨近端复杂骨折的疗效比较  

Efficacy comparison of conservative treatment with plate fixation and artificial humeral head replacement in the treatment of complex proximal humeral fractures in the elderly

作　　者：安雪军 徐宝山[3] 王小健[2] 闫兵山[3] 许海委 杜立龙[3] AN Xuejun;XU Baoshan;WANG Xiaojian;YAN Bingshan;XU Haiwei;DU Lilong(Graduate School of Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]山西省人民医院骨科,太原030012 [3]天津市天津医院,天津300000

出　　处：《实用医学杂志》2020年第5期613-618,共6页The Journal of Practical Medicine

基　　金：山西省重点研发计划项目(编号:201803D31160)。

摘　　要：目的比较保守治疗、切开复位锁定钢板内固定和人工肱骨头置换术治疗老年肱骨近端骨折的近期临床疗效。方法2011年7月至2016年7月共收治120例老年肱骨近端粉碎性骨折患者,男50例,女70例,平均年龄(76.2±3.6)岁。按Neer分型:三部分骨折58例,四部分骨折62例。34例患者选择保守治疗,44例患者行切开复位锁定板内固术,42例患者行人工肱骨头置换术。分别于术后3个月、12个月比较3组患者肩关节活动度、美国肩肘外科医师(ASES)评分、Constant-Murley评分及视觉模拟评分(VAS)。结果保守组患者术后3个月,肩关节活动度和ASES评分、Constant-Murley评分明显低于内固定组和置换组,而VAS评分高于内固定组和置换组。术后12个月保守组患者肩关节活动度和ASES评分、Constant-Murley评分及VAS评分与内固定组和置换组差距缩小;术后3个月置换组肩关节活动度和ASES评分、Constant-Murley评分及VAS评分优于内固定组,术后12个月内固定组肩关节活动度和ASES评分、Constant-Murley评分及VAS评分接近置换组患者。结论3种方法治疗老年肱骨近端复杂骨折均能获得比较满意的临床疗效,手术治疗术后早期疗效优于保守组,人工肱骨头置换术早期疗效最优。Objective To compare the recent clinical efficacy of non-surgical treatment,open reduction locking plate fixation and artificial humeral head replacement for the treatment of proximal humeral fractures in the elderly.Methods From July 2011 to July 2016,120 patients with proximal humeral fracture were enrolled(50 male and 70 female)with an average age of 76.2±3.6 years.According to the Neer classification of proximal humeral fmctures,58 patients were noted three-part fractures,62 in four-part fractures.34 patients were treated with nonsurgical treatment,44 patients underwent open reduction locking plate fixation,and 42 patients underwent artificial humeral head replacement.Shoulder range of motion,American Shoulder&Elbow Surgeons(ASES)score,Constant-Murley score and visual analogue score(VAS)were collected in 3 months and 12 months after surgery.Results 3 months after operation,the shoulder mobility,ASES score and Constant-Murley score in conservative group were significantly lower than those in internal fixation group and replacement group,while VAS score was higher than those in internal fixation group and replacement group.12 months after operation,the difference of shoulder joint mobility,ASES score,Constant-Murley score and VAS score between conservative group and internal fixation group and replacement group were narrowed.The shoulder mobility and ASES score,Constant-Murley score and VAS score in the replacement group were better than those in the internal fixation group 3 months after operation.The shoulder mobility and ASES score,Constant-Murley score and VAS score in the fixation group were close to those in the replacement group 12 months after operation.Conclusion All the three methods can obtain satisfactory clinical efficacy in the treatment of complex proximal humeral fractures in the elderly.The early curative effect of surgical treatment is better than that of conservative group,and the early curative effect of artificial humeral head replacement is the best.

关 键 词：肩关节 肱骨骨折 近端 外科手术 保守治疗 老年人 

分 类 号：R683[医药卫生—骨科学]