锁定钢板固定联合同种异体腓骨移植术与人工肱骨头置换术治疗老年肱骨近端复杂骨折的疗效对比研究  

Clinical outcomes and efficacy of locking plate fixation with fibular allograft augmentation versus shoulder hemiarthroplasty for complex proximal humeral fractures in elderly patients

作　　者：麦麦提依不巴吉·阿不都卡迪尔 原天祎 周治衡 刘洪江 吕青[1] 崔泳[1] Maimaitiyibubaji Abudukadier;Yuan Tianyi;Zhou Zhiheng;Liu Hongjiang;Lyu Qing;Cui Yong(Department of Orthopedics,the Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第五附属医院骨科中心,乌鲁木齐830011

出　　处：《中华解剖与临床杂志》2024年第8期552-559,共8页Chinese Journal of Anatomy and Clinics

摘　　要：目的:探讨锁定钢板固定联合同种异体腓骨移植术与人工肱骨头置换术治疗老年肱骨近端复杂骨折(PHF)的临床疗效。方法:回顾性队列研究。纳入2019年1月—2022年12月新疆医科大学第五附属医院骨科收治的老年复杂PHF患者42例,其中男13例、女29例,年龄60~83(70.7±7.9)岁。Neer分型三部分骨折12例,四部分骨折30例。42例患者按手术方式不同分为2组,采用锁定钢板固定联合同种异体腓骨移植术治疗25例为FA组,采用人工肱骨头置换术治疗17例为HA组。观察指标:(1)比较2组患者基线资料;(2)比较2组患者手术时间、术中出血量、住院时间、骨折愈合时间,以及术后切口感染、内固定失效、畸形愈合、大结节不愈合、肩关节僵硬、假体松动、关节脱位、肱骨头坏死等并发症发生情况。(3)术后12个月,采用肩关节Constant-Murley评分评估肩关节恢复情况,采用上肢功能障碍(DASH)评分评估肩关节功能,采用VAS评分评估患者肩关节疼痛情况,并进行组间对比分析。结果:2组患者性别、年龄、NEER分型、受伤机制、患肢侧别及受伤至手术时间等基线资料比较,差异均无统计学意义(P值均>0.05)。42例患者均顺利完成手术。FA组手术时间(119.2±13.8)min长于HA组的(105.9±12.8)min,术中出血量(232.6±46.3)mL少于HA组的(297.7±54.5)mL,差异均有统计学意义(t=3.16、4.16,P值均<0.05);而住院时间FA组(9.9±2.8)d、HA组(10.1±2.6)d,差异无统计学意义(P>0.05)。42例患者骨折均愈合,骨折愈合时间FA组为(11.9±1.0)个月,HA组为(12.5±1.1)个月,2组间差异无统计学意义(P>0.05)。术后2组各有1例切口感染,予治疗后愈合;其余患者术后切口均一期愈合。42例患者均获随访,随访时间12~15(12.7±1.4)个月。随访期间FA组1例、HA组2例患者发生肩关节僵硬,予保守治疗。FA组和HA组总体并发症发生率分别为8.0%(2/25)和3/17,差异无统计学意义(P>0.05)。术后12个月,FAObjective This study aims to investigate the clinical outcomes of locking plate internal fixation combined with fibular allograft augmentation(FA)and shoulder hemiarthroplasty(HA)in treating complex proximal humerus fracture(PHF)in elderly patients.Methods A retrospective cohort study was conducted.Forty-two elderly patients diagnosed with complex PHF admitted to the Department of Orthopedics of the Fifth Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2022 were analyzed.The participants included 13 males and 29 females,aged 60-83(70.71±7.9)years,and consisted of 12 patients of Neer classification three-part fracture and 30 patients of four-part fracture.Forty-two patients were divided into two groups according to different surgical methods:25 patients were placed in the FA group with locking plate combined with fibula allograft,and 17 patients were placed in the HA group with shoulder hemiarthroplasty.Outcome measures were as follows.(1)The clinical baseline data of the two groups were compared.(2)Operative time,intraoperative blood loss,hospital's day,and fracture healing time were compared between the two groups.The occurrence of related complications such as postoperative incision infection,internal fixation failure,malunion,non-union of great tubercle,shoulder stiffness,prosthesis loosening,joint dislocation,humeral head necrosis,and other complications during follow-up was recorded.(3)Constant-Murley score and the disabilities of the arm,shoulder,and hand(DASH)score were used to evaluate shoulder function.Visual analog score(VAS)was used to evaluate shoulder pain at the 12-month follow-up.The above indexes were compared between the two groups.Results Gender,age,NEER classification,injury mechanism,affected limb side,and time from injury to operation were not significantly different between the two groups(all P values>0.05).The operation was successfully conducted in all 42 patients successfully completed the operation.The operative time of the FA group([119.2±13.8]min)was

关 键 词：肱骨骨折 骨折固定术 内 锁定钢板固定 同种异体腓骨 人工肱骨头置换 

分 类 号：R687.3[医药卫生—骨科学]