切开复位内固定与人工肱骨头置换术治疗老年肱骨近端骨折的疗效

Effects of open reduction with internal fixation and hemiarthroplasty for elderly patients with proximal humeral fracture

目的探讨切开复位内固定(ORIF)与人工肱骨头置换术(HA)治疗老年肱骨近端骨折的疗效。方法回顾性分析2012年7月至2015年2月北京积水潭医院收治的62例老年肱骨近端骨折患者的临床资料。根据不同的手术方式分为ORIF组(35例)和HA组(27例)2组。观察并记录2组患者的手术时间、住院时间及并发症发生情况,于术后3个月、1年及2年对患者进行定期随访。采用肩关节ConstantMurley评分标准和欧洲五维健康量表(EQ-5D)评估患者的关节功能和生活质量。结果 HA组患者较ORIF组患者手术时间短、术中出血量少,差异有统计学意义(P>0.05),但2组患者的住院时间和并发症发生率差异无统计学意义(P>0.05)。末次随访时,ORIF组和HA组患者的Constant-Murley评分分别为(74.1±10.3)分和(70.9±12.1)分,EQ-5D评分指数分别为(0.76±0.13)分和(0.74±0.17)分,差异均无统计学意义(P>0.05)。结论 ORIF与HA均是治疗老年肱骨近端骨折的有效方法,患者的关节功能和生活质量均可得到明显改善。

Objective To analyze the effect of open reduction with internal fixation （ORIF） and hemiar- throplasty （HA） for elderly patients with proximal humeral fracture. Methods Sixty-two elderly patients with proximal humeral fracture who underwent surgical treatment were collected in this study from July 2012 to Febru-ary 2015 in Beijing Jishuitan Hospital. All the patients were divided into two groups according to different surgical treatment. There were 35 cases in ORIF group and 27 cases in HA group, respectively. Observed and recorded the operation time, hospitalization stay and complication rate of two groups. All the patients were followed up in 3 months, one year and 2 years by outpatient and telephone periodically. The final outcome were evaluated by the Constant-Murley scores and the EuroQol groups 5 domain questionnaire （EQ-5D）. Results The operation time of HA group was shorter than that of ORIF group, and the amount of bleeding was less, the difference was statisti-cally significant（P 〈0.05） , while the hospitalization stay and complication rate showed no significant difference between the two groups （P 〉0 . 05） . At the final follow-up, the Constant-Murley score of ORIF group and HA group were （74.1 ±10.3） and （7 0 .9 ±12.1） , while the EQ-5D index were （0 .7 6 ±0.13） and （0 .7 4 ±0.17） respectively, there was no significant difference（P 〉0.05） . Conclusion ORIF and HA are effective treatments for elderly patients with proximal humeral fracture. Both surgeries are contributed to early recovery of shoulder function and quality of life of pationts.