PHILOS内固定与半肩关节置换治疗肱骨近端复杂性骨折的疗效比较  

Comparison of the curative effects of PHILOS internal fixation and hemi shoulder arthroplasty in the treatment of complex proximal humeral fractures

作　　者：包献丰 赵永军 佘亚峰 BAO Xianfeng;ZHAO Yongjun;SHE Yafeng(Department of Orthopedics,the Second People's Hospital of Yixing,Yixing,Jiangsu 214221,China)

机构地区：[1]宜兴市第二人民医院骨科,江苏214221

出　　处：《中国骨科临床与基础研究杂志》2021年第4期159-165,共7页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的对比研究肱骨近端内固定锁定系统(PHILOS)内固定与半肩关节置换治疗肱骨近端复杂性骨折的临床效果。方法回顾性分析2017年5月—2020年5月宜兴市第二人民医院收治的90例肱骨近端复杂性骨折患者的临床资料,依据术式不同分为内固定组(n=44)和关节置换组(n=46),其中内固定组采取PHILOS内固定,关节置换组采取半肩关节置换术。比较两组围手术期相关指标、并发症和手术优良率,记录术前,术后1 d、3 d患者血清肌酸激酶(CK)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、P物质(SP)、神经肽Y(NPY)、5-羟色胺(5-HT)等组织创伤或疼痛相关指标和视觉模拟量表(VAS)评分,评估术前,术后3、12个月两组患者肩关节Neer评分和肩关节Constant评分。结果与内固定组相比,关节置换组手术时间更短,术中出血量、术后引流量更少,术后1 d、3 d血清CK、CRP、TNF-α、SP、NPY、5-HT水平及VAS评分更低(P<0.05);关节置换组术后并发症发生率为4%,低于内固定组的20%;关节置换组术后3个月Neer评分、Constant评分较内固定组高(P<0.05),术后12个月两组Neer、Constant评分及手术优良率比较,差异无统计学意义(P>0.05)。结论与PHILOS内固定相比,应用半肩关节置换术治疗肱骨近端复杂性骨折手术创伤轻微,疼痛介质分泌减少,术后并发症发生风险低,肩关节功能恢复迅速,但术后1年两种术式肩关节功能和手术疗效差异不大。Objective To compare the clinical effects of proximal humeral internal locking system(PHILOS)internal fixation and hemi shoulder arthroplasty for complex proximal humeral fractures.Methods Clinical data of 90 patients with complex proximal humerus fractures in the Second People's Hospital of Yixing from May 2017 to May 2020 were retrospectively analyzed.According to different procedures,they were divided into internal fixation group(n=44)and joint replacement group(n=46).PHILOS internal fixation was used in the internal fixation group,and hemi shoulder arthroplasty was used in joint replacement group.Perioperative related indicators,complications,and the excellent and good rate of patients in two groups were compared,Serum indexes for tissue trauma or pain-related indicators such as creatine kinase(CK),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),substance P(SP),neuropeptide Y(NPY),5-hydroxytryptamine(5-HT),as well as visual analogue scale(VAS)before surgery and at 1 d,3 d postoperatively were recorded,Neer score and Constant score of shoulder joint before operation,and at 3,12 months after operation were evaluated.Results In joint replacement group,operation time was shorter,estimate intraoperative blood loss and postoperative drainage were less than those in internal fixation group(P<0.05).At 1,3 d postoperatively,the serum CK,CRP,TNF-α,SP,NPY,5-HT levels and VAS scores in joint replacement group were all lower than those in internal fixation group(P<0.05).Postoperative complication rate in joint replacement group and internal fixation group was 4%,20%respectively.Neer and Constant scores at 3 months postoperatively in joint replacement group were higher than those in internal fixation group(P<0.05),while there was no statistically significant difference between two groups at 12 months postoperatively(P>0.05);Also,the excellent and good rate of patients in two group at 12 months after the surgery were similar(P>0.05).Conclusion Compared with PHILOS internal fixation,the application of hemi-shoulder

关 键 词：肩骨折 骨折固定术 内 骨板 关节成形术 置换 肩 疼痛 细胞因子类 肌酸激酶 C反应蛋白质 功能恢复 

分 类 号：R683.413[医药卫生—骨科学] R687[医药卫生—外科学]