人工肱骨头置换术治疗老年肱骨近端骨折临床分析

Effect of artificial humeral head replacement on proximal humerus fractures in elderly patients

目的评价人工肱骨头置换术治疗老年肱骨近端骨折的效果。方法肱骨近端粉碎性骨折老年患者72例,根据手术方法分为观察组36例和对照组36例,观察组行肱骨头置换术,对照组行锁定钢板内固定术,比较2组手术时间、术中出血量、术后引流量、住院时间和并发症发生情况,采用Constant-Murley评分系统对肩关节功能恢复情况进行评价。结果观察组手术时间((85.7±9.4)min)、术中出血量((187.6±29.7)mL)、术后引流量((60.5±6.4)mL)和住院时间((10.3±2.1)d)与对照组((103.1±11.2)min、(250.3±34.2)mL、(78.1±5.9)mL、(14.5±1.9)d)比较差异有统计学意义(P<0.05);术后3个月及1a观察组Constant-Murley评分((61.3±4.7)、(67.4±3.4)分)高于对照组((52.7±3.8)、(60.8±2.9)分)(P<0.05);观察组并发症发生率(11.1%)与对照组(16.7%)比较差异无统计学意义(P>0.05)。结论肱骨头置换术治疗老年肱骨头近端粉碎性骨折疗效确切,与锁定钢板内固定术相比,具有手术时间短、术中出血量少、住院时间短及并发症发生率低等优点。

Objective To evaluate the effect of artificial humeral head replacement on proximal humerus fractures in elderly patients. Methods Seventy-two elderly patients with proximal humerus fractures were divided into observation group and control group based on the operation methods, with 36 patients in each group. Observation group received artificial humeral head replacement and control group received locking plate. The operation duration, blood loss volume, postoperative drainage volume, hospitalization stay and complications were recorded in two groups. The shoulder function recovery was evaluated by using Constant-Murley scoring system. Results The operation duration, blood loss volume, postoperative drainage volume and hospitalization stay were （85.7±9.4） min, （187.6±29.7） mL, （60.5±6.4） mL and （10.3± 2. 1） days in observation group, significantly different from those in control group （（103. 1±11. 2） rain, （250.3±34.2） mL, （78.1±5.9） mL, （14. 5±1. 9） days） （P〈0.05）. Constant-Murley scores in 3 months and one year after operation were 61.3±4.7 and 67.4±3.4 in observation group, higher than those in control group （52.7±3.8, 60.8± 2.9） （P〈0.05）. There was no significant difference in the incidence of complications between observation group （11.1%） and control group （16. 7%） （P 〉0.05）. Conclusion The humeral replacement is effective for proximal humerus fractures in the elderly patients, with the advantages of shorter operation duration, less blood loss, shorter hospitalization stay and lower incidence of complications in comparison with locking plate fixation.