内固定术和半肩关节置换术治疗老年肱骨近端复杂骨折的病例对照研究

Comparison of internal fixation and semi shoulder arthroplasty in treating proximal humerus comminuted fractures in elderly

目的：探讨应用切开复位锁定板内固定术和半肩关节置换术治疗老年肱骨近端骨折的临床疗效。方法：自2009年10月至2011年10月，收治60岁以上老年肱骨近端3、4部骨折患者32例，分为内固定组20例和置换组12例。切开复位内固定组男6例，女14例；年龄63-82岁，平均（71．50＋5．45）岁；3部骨折8例，4部骨折12例；采用切开复位锁定板内固定术治疗。半肩关节置换术组男4例，女8例；年龄61～85岁，平均（72．80~6．80）岁；3部骨折5例，4部骨折7例；采用半肩关节置换术治疗。术后观察两组患者并发症情况，并采用EQ-5D指数评价术后生活质量，Constant—Murley评分评估肩关节功能。结果：所有患者获随访，时间12~24个月，平均18个月。术后切口均I期愈合。内固定组2例发生了严重并发症，其中1例为螺钉断裂，l例为肱骨头缺血性坏死。术后内固定纽和置换纽EQ一5D指数分别为0．65±0．12和0．67±0．12；Constant-Murley评分分别为63．20_＋11．35和66．80_＋11．96，两组比较差异无统计学意义（P〉0．05）。结论：切开复位锁定板内固定和半肩关节置换都可用于治疗老年肱骨近端复杂骨折，在生活质量及肩关节功能恢复上两者差异无统计学意义，但是置换组较内固定组并发症发生率低。

To explore clinical effectiveness of internal fixation and semi-shoulder arthroplasty in treating prox imal humerus comminuted fractures in elderly. Methods： From October 2009 and October 2011,32 patients aged over 60 years old with three and four-part fractures of proximal humeral were treated with internal fixation （20 cases） and semi-shoulder arthroplasty （12 cases）. In internal fixation group,there were 6 males and 14 females aged from 63 to 82 years old （ranged, 71.50＋5.45 ）, 8 cases with three-part fracture and 12 cases with four-part fracture, and treated with open reduction and locking plate internal fixation. While in semi-shoulder arthroplasty group,there were 4 males and 8 females aged from 61 to 85 years old （ranged,72.80＋6.80）, 5 cases with three-part fracture and 7 cases with four-part fracture, and treated with semi-shoulder arthroplasty. Postoperative complications were observed,EQ-5D was used to evaluate quality of life,and Constant-Murley score was used to assess functional outcomes. Results：All patients were followed up from 12 to 24 months with an average of 18 months. All injuries were healed at stage I . Two cases in internal fixation group occurred severe complications, including 1 case with screw fracture, 1 case with avascular necrosis of humeral head. EQ-5D in interal fixation group and semi-shoulder arthroplasty group were respectively 0.65＋0.12,0.67_＋0.12,Constant-Murley score respectively was 63.20_＋11.35 and 66.80_＋ 11.96, and with no statistical meaning between two goups （P〉0.05）. Conclusion ：There is no difference in qulity of life and functional recovery for the treatment of proximal humerus comminuted fractures by open reduction and internal fixation and se mi-shoulder arthroplasty. However, the complication rate in semi-shoulder arthroplasty was lower than that of internal fixation group.