两种术式治疗老年肱骨近端Ⅲ、Ⅳ型骨折的近期疗效比较

A comparative study of short-term effect on the senile complicated proximal humeral fracture with two different kinds of operation method

目的分析肱骨近端锁定钢板内固定术(LPHP)与人工肱骨头置换术(HHR)治疗老年肱骨近端Ⅲ、Ⅳ部分骨折的近期临床疗效。方法应用LPHP与HHR治疗老年肱骨近端骨折各17例和12例。统计两组切口长度、手术时间、术中出血量、住院时间及术后并发症发生率和肩关节功能恢复情况。结果 HHR组在手术切口长度、手术时间及术中出血量上优于LPHP组。LPHP组术后并发症6例,HHR组1例。HHR组在肩关节外展、外旋方面明显优于LPHP组(P<0.05)。结论在严格把握手术适应证前提下,近期HHR并发症明显少于LPHP,配合早期、规范的功能锻炼,HHR组病人肩关节总体功能恢复优于LPHP组。

Objective To analyze the treatment effect between the locking proximal humeral plate（LPHP） and humeral head replacement（HHR） on the senile complicated proximal humeral fracture.Methods Seventeen cases were treated with LPHP and 12 cases with HHR.The length of operative incision,operation time,amount of bleeding in operation,the duration of hospitalization,postoperative complications and curative effect were recorded and analyzed.Results HHR was better than LPHP in the length of operative incision,the operation time and amount of bleeding in operation.Six cases of complications occurred in LPHP group,1 case in HHR group.The incidences of complication were 35.3% and 8.3%,respectively,significantly different between the two groups（P 〈 0.05）.HHR group is superior to LPHP group in shoulder abduction and external rotation（P 〈 0.05）.Conclusions On premise of strict operation indications,HHR for the short-term treatment of senile proximal humeral III,IV fractures has less complications,whose curative effect is better than that of LPHP with early functional exercise.