反式肩关节置换与切开复位钢板内固定治疗老年肱骨近端Neer三/四部分骨折的临床疗效研究  

Clinical study of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for treatment of Neer three/four-part proximal humeral fractures in elderly

作　　者：杨育晖 邓展涛 黎庆钿 张秀瑞 彭韵芝 张瑞英 马元琛 郑秋坚[1] YANG Yuhui;DENG Zhantao;LI Qingtian;ZHANG Xiurui;PENG Yunzhi;ZHANG Ruiying;MA Yuanchen;ZHENG Qiujian(Department of Orthopedics,Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou Guangdong,510080,P.R.China;Department of Orthopedics,Guangdong Provincial People’s Hospital Ganzhou Hospital,Ganzhou Jiangxi,341000,P.R.China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)骨科,广州510080 [2]广东省人民医院赣州医院骨科,江西赣州341000

出　　处：《中国修复重建外科杂志》2025年第4期412-419,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省基础与应用基础研究基金(2023A1515110657、2023A1515220181);赣州市重点研发计划研究基金(GZ2024YLJ089);赣州市科技计划项目(GZ2024ZSF122、GZ2024ZSF118)。

摘　　要：目的比较反式肩关节置换(reverse total shoulder arthroplasty,RTSA)和切开复位钢板内固定(open reduction and internal fixation,ORIF)治疗老年肱骨近端Neer三/四部分骨折的临床疗效。方法随机对照分析2020年1月—2022年6月接受RTSA和ORIF治疗的68例70岁以上肱骨近端Neer三/四部分骨折患者。患者随机分为RTSA组(32例)和ORIF组(36例),两组患者年龄、性别、身体质量指数、损伤侧别、Neer分型及术前Charlson合并症指数、疼痛视觉模拟评分(VAS)、肩关节Constant评分、牛津大学肩关节评分(OSS)、血红蛋白(hemoglobin,Hb)等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、手术出血量、术后第3天Hb较术前减少量、住院时间、住院总费用、并发症发生情况及术后2年肩关节活动度,术前及术后5 d、1个月VAS评分,术前及术后2年Constant评分、OSS评分,以及随访期间影像学结果。结果与ORIF组比较,RTSA组手术时间增加,手术出血量减少,住院总费用显著增高,差异有统计学意义(P<0.05);两组术后第3天Hb减少量差异无统计学意义(P>0.05)。两组术后5 d、1个月VAS评分均较术前显著改善(P<0.05),但两组间差异无统计学意义(P>0.05)。所有患者均获随访,随访时间26~35个月,平均31.2个月。RTSA组出现切口浅表愈合不良2例、一过性神经损伤1例,所有患者均未出现人工关节周围骨吸收、透亮带、假体松动或假体周围骨折等并发症;ORIF组出现切口浅表愈合不良1例,骨折不愈合3例,肱骨头坏死继发关节炎改变1例,大结节骨吸收1例,所有患者未发现内固定物移位或断裂失效等改变。两组患者并发症发生率比较[9.4%(3/32)vs 16.7%(6/36)]差异无统计学意义[OR(95%CI):0.828(0.171,4.014),P=0.814]。术后2年RTSA组Nerot-Sirveaux分级为0级28例、1级4例。RTSA组Constant评分和OSS评分手术前后差值均优于ORIF组(P<0.05);其中Constant评分的活动与力量�Objective To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty(RTSA)and open reduction and internal fixation(ORIF)in the treatment of Neer three/four-part proximal humeral fractures in the elderly.Methods Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022.The patients were randomly divided into RTSA group(n=32)and ORIF group(n=36).There was no significant difference(P>0.05)in the baseline data such as age,gender,body mass index,injured side,Neer classification,and preoperative Charlson comorbidity index,visual analogue scale(VAS)score,Constant shoulder score,Oxford shoulder score(OSS),and hemoglobin(Hb).The operation time,intraoperative blood loss,reduction of Hb on the 3rd day after operation,hospital stay,total cost of hospitalization,complication incidence,range of motion of shoulder joint at 2 years after operation,VAS score before operation and at 5 days and 1 month after operation,Constant shoulder score and OSS score before operation and at 2 years after operation,and imaging results during follow-up were recorded and compared between the two groups.Results Compared with the ORIF group,the RTSA group had longer operation time,less intraoperative blood loss,and higher total cost of hospitalization(P<0.05).There was no significant difference in Hb reduction on the 3rd day after operation between the two groups(P>0.05).The VAS scores significantly improved in both groups at 5 days and 1 month after operation(P<0.05),but there was no significant difference between the two groups(P>0.05).All patients were followed up 26-35 months,with an average of 31.2 months.In the RTSA group,there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury.There was no complication such as bone resorption around the prosthesis,lucent band,prosthesis loosening,or periprosthetic fracture in all patients.In the ORIF group,t

关 键 词：肱骨近端骨折 反式肩关节置换 切开复位钢板内固定 老年患者 骨质疏松性粉碎骨折 

分 类 号：R687.3[医药卫生—骨科学]