切开复位内固定与肱骨头置换术对于肱骨近端粉碎性骨折患者肩关节功能恢复的疗效比较  

Efficacy of open reduction and internal fixation versus humeral head replacement in the recovery of shoulder joint function in patients with comminuted fractures of the proximal humerus

作　　者：吕文强 王涛[1] Lyu Wenqiang;Wang Tao(Department of Orthopedics,Xi'an Gaoxin Hospital,Xi'an 710075,Shaanxi Province,China)

机构地区：[1]西安高新医院骨科,西安710075

出　　处：《中国基层医药》2025年第3期414-419,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的比较切开复位内固定与肱骨头置换术对于肱骨近端粉碎性骨折患者肩关节功能恢复的疗效。方法本研究为病例对照研究,选择2020年1月至2023年12月期间西安高新医院骨科接诊后采用手术治疗的肱骨近端粉碎性骨折患者80例的数据实施回顾性分析。依据手术方法不同将患者分为两组:对照组(n=45)给予切开复位内固定治疗术,观察组(n=35)给予肱骨头置换术。比较两组患者的手术相关指标、术后3个月的治疗效果评级、肩关节活动度、肩关节功能状态、并发症发生率。结果观察组术中失血量、手术时间、术后引流量、术后住院时间分别为(186.92±28.04)mL、(68.89±10.12)min、(57.89±11.25)mL、(10.18±2.41)d,均明显低于对照组的(218.23±35.57)mL、(98.26±15.34)min、(73.65±13.68)mL、(12.35±2.92)d,差异均有统计学意义(t=4.27、9.78、5.51、3.55,均P<0.05)。两组患者术后3个月的疗效差异无统计学意义[97.14%(34/35)比95.56%(43/45)](χ^(2)=0.04,P>0.05)。观察组患者在治疗后3个月的前屈上举、外旋、内旋的角度分别为(95.42±7.88)°,(61.37±6.56)°,(74.38±5.01)°,对照组分别为(93.68±7.75)°,(60.42±6.87)°,(73.75±4.92)°,差异均无统计学意义(t=-0.98、-0.62、-0.56,均P>0.05)。观察组在治疗后3个月的肩关节功能状态评分为(73.46±9.15)分,对照组为(71.75±8.66)分,差异无统计学意义(t=-0.85,P>0.05)。观察组并发症发生率为2.86%(1/35),明显低于对照组的22.22%(10/45),差异有统计学意义(χ^(2)=4.70,P=0.030)。结论针对肱骨近端粉碎性骨折患者,切开复位内固定与肱骨头置换术两种方法均可以取得很好的肩关节功能恢复,而肱骨头置换术在围手术期的优势更为明显。Objective To evaluate the effect of open reduction and internal fixation versus humeral head replacement on postoperative recovery of shoulder joint function in a population of patients with comminuted fractures of the proximal humerus.Methods This study was a case-control study that retrospectively analyzed data from 80 patients with comminuted fractures of the proximal humerus who underwent surgical treatment at the Department of Orthopedics at Xi'an Gaoxin Hospital from January 2020 to December 2023.The patients were divided into two groups based on the surgical method:the control group(n=45)received open reduction and internal fixation,while the observation group(n=35)underwent humeral head replacement.Surgery-related indexes,as well as therapeutic effect ratings,shoulder joint mobility,and shoulder joint function 3 months post-surgery,were compared between the two groups.Additionally,the incidence of complications occurring during the treatment was also compared between the two groups.Results In the observation group,the intraoperative blood loss,surgery duration,postoperative drainage amount,and length of hospital stay were(186.92±28.04)mL,(68.89±10.12)minutes,(57.89±11.25)mL,and(10.18±2.41)days,respectively,all of which were significantly lower than those in the control group,which were(218.23±35.57)mL,(98.26±15.34)minutes,(73.65±13.68)mL,and(12.35±2.92)days(t=4.27,9.78,5.51,3.55,all P<0.05).There was no statistically significant difference in the therapeutic effect between the two groups 3 months post-surgery[97.14%(34/35)vs.95.56%(43/45),χ^(2)=0.04,P>0.05].At 3 months post-surgery,the angles of forward elevation,external rotation,and internal rotation in the observation group were(95.42±7.88)°,(61.37±6.56)°,and(74.38±5.01)°,respectively,while in the control group they were(93.68±7.75)°,(60.42±6.87)°,and(73.75±4.92)°,respectively.The differences were not statistically significant between the two groups(t=-0.98,-0.62,-0.56,all P>0.05).At 3 months post-surgery,the shoulder function scor

关 键 词：肱骨 骨折 粉碎性 骨折切开复位 骨折固定术 内 关节成形术 置换 肩关节 失血 手术 手术后并发症 

分 类 号：R68[医药卫生—骨科学]