PHILOS锁定钢板与人工肱骨头置换治疗老年复杂肱骨近端骨折的效果对比

Clinical effectiveness analysis of PHILOS locking plates and humeral head replacement for treatment of complex fractures of proximal humerus in elderly

目的：对比分析PHILOS锁定钢板内固定术与人工肱骨头置换术治疗老年复杂肱骨近端骨折的临床疗效。方法回顾性分析60岁以上老年肱骨近端三、四部分骨折患者43例临床资料，其中PHILOS组32例，人工肱骨头置换组11例。比较两组患者手术时间、手术出血量、NEER评分及术后并发症发生率。结果所有患者均获得门诊随访，随访时间6～20个月，平均11．63个月。两组手术时间及手术出血量比较差异无统计学意义（P＞0．05）；治疗后，根据NEER评分评估疗效，两组比较差异无统计学意义（P＞0．05）；但术后PHILOS组并发症发生率高于人工肱骨头置换组，术后有2例发生钢板与肩峰撞击综合征，2例发生螺钉穿入肩关节，但无功能影响，1例术后大结节移位，1例发生肱骨头坏死，人工股骨头置换组无并发症发生。结论 PHILOS钢板内固定与人工肱骨头置换均可用于治疗老年复杂肱骨近端骨折，在生活质量及肩关节功能恢复上无明显差异，但人工肱骨头置换组术后并发症发生率较PHILOS组低。

Objective To analyze the effect of PHILOS locking plate fixation and the artificial humerus head replacement on proxi-mal complex humerus fracture. Methods The clinical data of 43 patients aged over 60 with three or four parts fractures in proximal humerus were retrospectively studied,including 32 cases of PHILOS group and 11 cases of artificial humerus head replacement group. Two groups were compared in operation time,surgical blood loss and NEER score and the incidence of postoperative complications. Results All patients obtained similar outpatient follow-up for 6~20 months with an average of 11. 63 months. There was no difference in operation time and blood loss of the two groups(P>0. 05). After treatment,according to NEER grading evaluation of curative effect,no obvious statistical significance difference existed between the two groups (P>0. 05). However,the postoperative complication rate of PHILOS group was higher than that of artificial humerus head replacement group;postoperative plate and acromion impingement occurred in 2 cases,screw through the shoulder joint in 2 cases,but there was no functional impact,and there was 1 case of displacement of the greater tuberosity postoperatively,1 case of humerus head necrosis,while there were no complications in artificial femoral head replacement group. Conclusion PHILOS or steel plate internal fixation and the artificial humerus head replacement can be used in the treatment of senile complex humeral proximal fractures. There are no obvious differences in the quality of life and shoulder joint function recovery,but the incidence of postoperative complications in artifi-cial humerus head replacement group is lower than that of PHILOS group.