切开复位锁定板内固定术与半肩关节置换术治疗老年肱骨近端骨折的临床效果对比

Clinical effect comparison of open reduction and internal fixation with locking plate fixation and semi shoulder arthroplasty in the treatment of proximal humeral fractures in elderly patients

目的探讨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效果。方法选取2014年9月~2015年12月我院收治的80例老年肱骨近端骨折患者,根据手术方式的不同分为内固定组和置换组,各40例。内固定组应用切开复位锁定板内固定术治疗,置换组应用半肩关节置换术治疗,比较两组的临床治疗效果。结果两组的手术时间比较,差异无统计学意义(P>0.05)。置换组的术中出血量显著少于内固定组,差异有统计学意义(P<0.05)。两组治疗前的Neer评分比较,差异无统计学意义(P>0.05)。两组治疗后的Neer评分显著高于治疗前,差异有统计学意义(P<0.05)。置换组治疗后的Neer评分显著高于内固定组,差异有统计学意义(P<0.05)。置换组的优良率显著高于内固定组,差异有统计学意义(P<0.05)。置换组治疗后的并发症发生率显著低于内固定组,差异有统计学意义(P<0.05)。术后随访3个月,置换组出现内固定松动、脱位、切口感染及慢性疼痛等的并发症发生率显著低于内固定组,差异有统计学意义(P<0.05)。结论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中均具有较好的临床治疗效果,而半肩关节置换术在术中出血量以及术后Neer评分等方面优于切开复位锁定板内固定术,值得临床推广应用。

Objective To explore the clinical effect of open reduction and internal fixation with locking plate fixation and semi shoulder arthroplasty in the treatment of proximal humeral fractures in elderly patients.Methods 80 cases of elderly patients with proximal humeral fractures treated in our hospital from September 2014 to December 2015 were selected and divided into the internal fixation group and the replacement group according to the different operation methods,40 cases in each group.The internal fixation group was used open reduction and locking plate fixation,the replacement group was used semi shoulder arthroplasty,and the clinical therapeutic effect of the two groups were com- pared.Results There was no statistical difference between the two groups in the operation time （P〉0.05）.The amount of intraoperative bleeding in the replacement group was significantly less than that in the internal fixation group,with sig- nificant difference （P〈0.05）.There was no significant difference between the two groups in the Neer score before treatment （P〉0.05）.The Neer scores of the two groups after treatment was significantly higher than that before treatment,with sig- nificant difference （P〈0.05）.The Neer score in the replacement group after treatment was significantly higher than that in the internal fixation group,with significant difference （P〈0.05）.The excellent and good rate of the replacement group was significantly higher than that of the internal fixation group,with significant difference （P〈0.05）.The incidence rate of complications in the replacement group was significantly lower than that in the internal fixation group,with significant difference （P〈0.05）.The follow-up period was 3 months,the incidence rate of complications such as internal fixation loosening, dislocation,incision infection and chronic pain in the replacement group was significantly lower than that in the internal fixation group,with significant difference （P〈0.05）.Conclusion Open reduction and locking plate fixation and semi shoulder arthroplasty in the treatment of elderly patients with proximal humeral fractures have a good clinical treatment effect, and the amount of blood loss and postoperative Neer score were superior to open reduction and locking plate fixation in this study,which is wortyhy of clinical promotion and application.