肱骨头置换治疗肱骨近端粉碎性骨折与锁定钢板治疗的对比

Humeral head replacement versus locking plate in treating proximal humeral fractures

背景:NeerⅢ型、Ⅳ型肱骨近端骨折是较难处理的骨折类型,一直争议较多。目的:比较肱骨近端骨折采用肱骨头置换治疗与锁定钢板治疗的效果。方法:对2004-06/2006-08收治的26例有完整随访资料的应用肱骨头置换治疗肱骨近端粉碎性骨折患者的疗效进行回顾性分析,26例患者采用人工肱骨头置换治疗。以文献检索的锁定钢板治疗方法及常规内固定方法,选折治疗对象相似、疗效评价标准相同的研究作为对照。按Neer评分标准比较3种方法的治疗效果及并发症发生情况。结果与结论:26例全部随访,随访时间为11～36个月,平均24个月。按Neer评分标准优11例,满意13例,不满意2例。与文献报道采用锁定钢板组比较差异无显著性意义(P>0.05),但疗效优于常规内固定组P<0.05)。并发症:肱骨头置换组疼痛2例;锁定钢板组肱骨头坏死6例,疼痛3例;常规手术组感染1例,肩峰撞击4例,肱骨头坏死6例,疼痛6例。结果提示,在严格掌握手术适应证的前提下,人工肱骨头置换能减轻患者的疼痛、恢复肩关节的功能和稳定性。

BACKGROUND：Type Neer Ⅲ and Ⅳ proximal humeral fractures are difficult to treat. OBJECTIVE：To compare the clinical effects of humeral head replacement and locking plate in treating proximal humerus comminuted fractures. METHODS：The effects of 26 cases undergoing humeral head replacement in treating proximal humerus comminuted fractures from June 2004 to August 2006 were analyzed retrospectively. The 26 cases were hospitalized and treated with humeral head replacement. Patients treated with locking plate or routine internal fixation methods were retrieved and served as control. Neer evaluation was used to compare the efficacy and complications. RESULTS AND CONCLUSION：All 26 cases were followed-up from 11 to 36 months with an average of 24 months. According to the standard of Neer,there were 11 cases of excellent,13 of satisfied,and 2 of unsatisfied. There were no significant differences in locking plate group （P 0.05）,but superior over conventional fixation group （P 0.05）. The complications included pain in 2 cases of humeral head replacement group; 6 humeral head necrosis and 3 pain in locking plate group; 1 infection,4 acromion impingement,6 humeral head necrosis and 6 pain. Results showed that under rigorous operative indications,the operation of humeral head replacement can alleviate or eliminate patients＇ pain and help restore the function and stability of the shoulder joint.