锁定钢板与半肩关节置换治疗老年肱骨近端骨折疗效比较

Therapeutic Effect of Locking Plate and Semi Shoulder Joint Replacement for Proximal Humeral Fracture in Senile

目的：比较锁定钢板（Locking plate,LP）与半肩关节置换（semi-shoulder arthroplasty,SSA）治疗老年肱骨近端NeerⅢ、Ⅳ型骨折临床疗效。方法：对我院骨科2009年5月至2013年5月收治的61例老年肱骨近端NeerⅢ、Ⅳ型骨折的患者资料进行回顾性分析,男性18例,女性43例,年龄60-84岁,平均69.3岁。其中采用LP治疗者40例,采用SSA治疗者21例,观察两组患者的手术时间、失血量、Neer评分情况,记录手术并发症情况,并进行统计学比较。结果：所有患者均获得随访,平均随访时间14.5个月（12-20个月）。LP组手术时间（105.6±20.4 min vs 80.6±18.2 min,t=2.650,P=0.01）多于SSA组,两组在手术出血量（188.5±25.2 ml vs 200.5±31.6 m L,t=1.666,P=0.1）、Neer评分优良率（92.5%vs 90.5%,X2=0.075,P=0.784）和并发症发生率（4.8%vs12.5%,X2=1.351,P=0.245）无明显差异。结论：在老年肱骨近端NeerⅢ、Ⅳ型骨折的治疗上,SSA手术时间短,但手术并发症发生率以及疗效优良率与LP相似,临床应根据病情及需要灵活选择手术方式。

Objective： To compare the clinical effect of locking c plates（LP） and semi-shoulder arthroplasty（SSA） for proximal humerus fractures Neer type Ⅲ and Ⅳ in eldly. Methods： From May 2009 to May 2013, 61 patients（18 males and 43 females） with proximal humerus fractures Neer type Ⅲ and Ⅳ who aged 60 to 84 years（mean, 69.3 years） were treated with LP including 40 cases and with SSA including 21 cases. The indexes including operation time, blood loss, and Neer score were statistically compared and complications were recorded. Results： All patients were followed up with an average of 14.5 months（12-20 months）. The operation time in SSA group（80.6±18.2 min） were significantly less than that of LP group（105.6±20.4） min with statistical significance（t= 2.650, P=0.01）. Blood loss（188.5±25.2 m L vs 200.5±31.6 m L, t=1.666, P= 0.1）, Neer score excellent-and-good rate（92.5 % vs 90.5 %, X2=0.075, P=0.784） and the incidence of complications（4.8 % vs 12.5 %, X2=1.351, P=0.245）showed no significant differences between two groups. Conclusions： For the proximal humerus fractures of Neer type Ⅲ and Ⅳ in eldly, SSA has the advantage of shorter operation time and but the recurrence of complications and curative effect is similar to LP.