内固定与肱骨头置换治疗高龄肱骨近端骨折比较  

Comparison of internal fixation with locking proximal humeral plate versus humeral hemiarthroplasty for complex proximal humeral fractures in the elderly

作　　者：刘小雷 王炎[1] 孙中仪 汪海滨[1] 田纪伟 丁志勇 LIU Xiao-lei;WANG Yan;SUN Zhong-yi;WANG Hai-bin;TIAN Ji-wei;DING Zhi-yong(Orthopaedic Center,Nanjing Jiangbei Hospital,Nantong University,Nanjing 210048,China)

机构地区：[1]南通大学附属南京江北医院骨科中心,江苏南京210048

出　　处：《中国矫形外科杂志》2022年第2期107-112,共6页Orthopedic Journal of China

摘　　要：[目的]比较切开复位解剖锁定钢板内固定术(lockingproximalhumeralplate,LPHP)与肢骨头置换(humeralhemiar-throplasty,HHA)治疗高龄患者复杂肱骨近端骨折的临床疗效。[方法]回顾性分析2015年1月一2018年1月,手术治疗78例高龄(英80岁)复杂肱骨近端骨折(Neer三、四部分骨折)的临床资料。依据术前医患沟通结果,46例采用LPHP内固定(LPHP组),32例采用HHA(HHA组)。比较两组临床资料、并发症、肩关节功能Neer评分、ASES评分和Constant-Murley评分及影像学资料。[结果]两组均顺利完成手术,无严重术中并发症。HHA组术中出血量和手术时间显著优于LPHP组,差异有明显统计学意义(P<0.05);两组透视次数、术后输血、住院天数和围术期并发症方面差异无统计学意义(P>0.05)。两组均获得随访12~18个月,平均随访(13.87±2.84)个月。不良事件,LPHP组为14/46(30.43%),HHA组为5/32(15.63%),两组间差异无统计学意义(P=0.134)。两组主动活动时间、完全负重时间比较差异无统计学意义(P>0.05)。术后相应时间点,HHA组的前屈上举ROM小于LPHP组,而HHA组的Neer、ASES和Constant-Murley评分均高于LPHP组,但是两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,与术后即刻相比,末次随访时两组的肩肱间间隙(AHI)和肱骨颈干角(HNSA)均无显著改变(P<0.05),相应时间点,两组间AHI的HNSA的差异均无统计学意义(P<0.05)。至末次随访时,LPHP组46例中,9例内固定螺丝钉松动或穿出,5例肱骨头缺血坏死,11例骨折愈合不良,包括骨折未愈合、延迟愈合等。HHA组32例中,3例假体周围骨折,2例肱骨大小结节愈合不良。[结论]两种治疗高龄复杂肱骨近端骨折均可取得较好临床效果,行HHA更有利于早期康复功能锻炼,改善肩关节功能。[Objective]To compare the clinical outcomes of locking proximal humeral plate(LPHP)versus humeral hemiarthroplasty(HHA)for complex proximal humeral fractures in the elderly.[Methods]A retrospective study was done on 78 elderly patients(^80 years old)who underwent surgical treatment for complex proximal humeral fractures(Neer type Ⅲ and IV fractures)from January 2015 to January 2018.According to the results of preoperative doctor-patient communication,46 patients received LPHP for open reduction and internal fixation,while the remaining 32 patients had HHA performed.Clinical documents,such as complications,Neer,ASES and Constant-Murley scores,as well as radiographic data were compared between the two groups.[Results]All the patients in both groups were successfully operated on without serious intraoperative complications.The HHA group had significantly less intraoperative blood loss and operation time than the LPHP group(P<0.05),although there were no statistically significant differences in terms of number of fluoroscopy,postoperative blood transfusion,hospital stay and perioperative complications between the two groups(P>0.05).All patients in both groups were followed up for 12-18 months,with an average of(13.87±2.84)months.Adverse events were of 14/46(30.43%)in the LPHP group,5/32(15.63%)in the HHA group,which was not statistically significant(P=0.134).There were no significant differences in terms of time to resume active motion and time to recover full weight-bearing activity between the two groups(P>0.05).At corresponding postoperative time points,HHA group had less forward extension ROM,while higher Neer,ASES and Constant-Murley scores than LPHP group,despite of the fact that no statistically significant differences were noticed in the abovementioned items between the two groups(P>0.05).Radiographically,the acromiohumeral interval(AHI)and humeral neck-shaft angle(HNSA)remained unchanged significantly in the two groups at the lat-est follow-up compared with those immediately after surgery(P>0.05),and ther

关 键 词：高龄 复杂肱骨近端骨折 锁定肱骨近端钢板 肱骨头置换 

分 类 号：R683.41[医药卫生—骨科学]