锁定钢板与解剖钢板治疗肱骨近端骨折的疗效对比分析

Comparison of locking plate and anatomical type plate in the treatment of proximal humeral fracture

[目的]比较锁定钢板和解剖钢板治疗肱骨近端骨折的疗效,为临床选择适当的治疗方法提供依据。[方法]对2005年1月～2008年1月在本科进行治疗的115例肱骨近端骨折患者进行回顾分析,其中53例用肱骨近端锁定接骨板内固定治疗(LP组),62例采用解剖钢板内固定治疗(AP组),并从术中出血、骨折愈合时间、并发症发生率、治疗费用和关节功能评价等方面进行比较分析。[结果]两组病例均获随访6个月以上,两组骨折愈合时间无统计学差异(P>0.05),另在治疗费用LP组(19429±344)元明显高于AP组(12485±257)元(P<0.01),而术中出血量和术后并发症发生率LP组显著低于AP组(P<0.01),分别是(225±25)和(362±29)ml及1.89%和12.9%。手术疗效根据Neer评定标准,LP组优良率为96.2%,显著高于AP组82.3%(P<0.01)。[结论]尽管锁定钢板治疗肱骨近端骨折费用相对较高,但其具有创伤小、固定牢靠,并发症少、功能恢复良好等优点,尤其适合老年骨质疏松患者的治疗。

[Objective]To investigate the therapeutic effect on proximal humeral fracture for two kinds of treatment methods and make theoretical analysis to offer basis on choosing the proper treatment method in clinic.[Methods]The clinical and radiological records of 115 patients with proximal humeral fracture for two kinds of different treatment were reviewed：open reduction and internal fixation with locking plate（53 cases,group LP） and anatomical type plate（62 cases,group AP） from January 2005 to January 2008.The bleeding volume,union of fracture time,incidence of complications,total cost of hospitalization and Neer scores（functional outcome was assessed with the Neer scores） were compared in different methods.[Results]All the patients were followed up for above 6 months.Compared to group AP,Group LP was significantly lower in the bleeding volume（225±25） ml vs.（362±29） ml,the incidence of complications 1.89% vs.12.9%（P0.01）,and higher rate of the Neer Score 96.2% vs.82.3%（P0.01）.In term of average hospital costs,LP group（19 429±344） RMB was higher than AP group（12 485±257） RMB（P0.01）.But the union of fracture time were not statistically significant between the two groups（P0.05）.[Conclusion]The clinical results of using locking plate in proximal humeral fracture were found to be satisfactory,specially for osteoporotic fractures.Despite more spending,it has the advantage of reliable fixation,less surgical trauma and less complication,should be cared for and emphasized in clinic.