【摘要】 目的对比分析人工肱骨头置换术和肱骨近端锁定钢板治疗老年复杂肱骨近端骨折的近期疗效。方法回顾性分析本院骨科2012年1月~2014年6月采用人工肱骨头置换术和肱骨近端锁定钢板治疗的老年(年龄>65岁)NeerⅢ、Ⅳ部分肱骨近端骨折患者54例,人工肱骨头置换治疗(置换组)30例,肱骨近端锁定钢板内固定治疗(内固定组)24例。比较分析两组手术时间、术中出血量、随访Neer评分及Constant-Murley评分来评定两组临床疗效。结果两组随访时间相仿,平均随访时间为19.5个月(12~36个月)。内固定组手术时间(101±13)分钟、术中出血量(237.9±32.4)m L、Neer评分(82.5±3.2)、Constant-Murley评分(71.7±5.0);置换组手术时间(98±11)分钟、术中出血量(246.0±39.8)m L、Neer评分(82.9±4.5)、Constant-Murley评分(73.5±5.0)。两组手术时间、术中出血量、随访Neer及Constant-Murley评分比较差异均无统计学意义(>0.05)。内固定组有1例出现肩关节半脱位,肱骨头置换组有2例出现肩关节半脱位,通过三角巾悬吊后关节脱位均得到纠正。有1例四部分骨折患者,行内固定术后出现内固定松动、肱骨头坏死,改行人工肱骨头置换术。结论人工肱骨头置换术和肱骨近端锁定钢板治疗老年肱骨近端复杂骨折的近期临床疗效相似,对不可修复的肱骨近端骨折宜行肱骨头置换术。更多还原

【Abstract】 Objective To compare and analyze the short-term clinical efficacy of hemiarthroplasty versus open reduction and locking plate internal fixation for complicated proximal humeral fractures in old patients. Methods The retrospective data of 54 cases deal with locking plate(24 cases)or hemiarthroplasty(30 cases)for treatment of complicated proximal humeral fractures were collected from January 2012 to June 2014 in our hospital. They were part three and part four fractures(Neer classification). The two groups were compared with each other in such parameters as operative time, blood loss, Neer and Constant-Murley shoulder scores at last follow-up. Results The follow up was ranging from 12 to 36months(mean 19.5months). In the locking plate group: the mean operative time was(101±13) min, the mean intraoperative blood loss was(237.9±32.4)m L, Neer scores was(82.5±3.2)and the Constant-Murley scores was(71.7±5.0);In the hemiarthroplasty group: the mean operative time was(98±11)min, the mean intraoperative blood loss was(246.0±39.8) m L, Neer scores was(82.9±4.5) and the Constant-Murley scores was(73.5±5.0). There were no statistical differences in the two groups( >0.05). One patient with instability of shoulder joint was found in locking plate group,while two patients with instability of shoulder joint were found in hemiarthroplasty group. The instability was corrected by the triangle towel hanging. One patient with loosening of plate and aseptic necrosis of head of humeral in locking plate group was underwent hemiarthroplasty. Conclusion The therapy of open reduction and locking plate internal fixation is similar to hemiarthroplasty in the short-term effect for complicated proximal humeral fractures in old patients. Hemiarthroplasty is batter for non repairable complicated proximal humeral fractures in old patients.更多还原