解剖型异体腓骨髓内支撑钢板内固定术治疗老年肱骨近端粉碎性骨折疗效观察

Clinical outcomes of locking compression plate with intramedullary anatomical fibular allograft for proximal humerus fractures in older people

目的观察解剖型腓骨髓内支撑锁定钢板内固定术(lock compression plate with fibular allograft,F-LCP)治疗老年粉碎性肱骨近端骨折的中远期临床疗效。方法选取2010年1月-2013年12月住院接受手术的肱骨近端四部分骨折患者49例,接受肩关节置换术(hemiarthroplasty,HA)20例作为对照组,接受解剖型腓骨髓内支撑锁定钢板内固定术29例作为观察组,比较两组疗效指标,包括肩关节功能评分(constant-murley score,CMS)、肩手残疾评分(disability of the arm,shoulder and hand,DASH)、肩关节活动范围、患者满意度等。结果两组患者性别、年龄、受伤机制、骨密度等差异均无统计学意义(P均>0.05)。HA组平均随访时间63.2(48~72)个月,F-LCP组平均随访时间60.5(48~72)个月。F-LCP组CMS评分(70.3±13.9)明显高于HA组(57.3±12.7),肩关节活动范围(22.5±8.9)优于HA组(15.3±3.1)(P<0.05),两组DASH评分差异无统计学意义。观察组中1例出现肱骨头坏死、1例出现螺钉切出。对照组中1例出现感染、4例出现肩关节僵硬、1例出现大结节移位。其他均达到临床愈合标准。结论解剖型腓骨支撑锁定钢板内固定术术后患肢功能恢复优于肩关节置换术。

Objective To compare the clinical outcomes and complications between hemiarthroplasty （HA） and locking compression plate （LCP） with fibular allograft in treatment of older patients with comminuted proximal humerus fracture （PHF）. Methods From January 2010 to December 2013, a total of 49 older patients with displaced PHF who were treated by HA （n=20） or LCP with fibular allograft （n=29） were included in our study. Function outcomes were assessed by the disability of the arm, shoulder and hand （DASH） score, constant-murley score （CMS）, and complications were also recorded in each group. Results There was no significant difference in age, sex, mechanism of injury, and bone mineral density （all P 〉 0.05）. The average follow-up was 63.2 months （range, 48-72 months） in HA group and 60.5 months （range, 48-72 months） in F-LCP group. CMS score in F-LCP group was significantly higher than that in HA group [（70.3 ± 13.9） vs （57.3 ± 12.7）, P=0.004], while there was no significant difference in DASH score between the two groups. Range of motion （ROM） in F-LCP group was significantly higher than that in HA group [（22.5 ± 8.9） vs （15.3 ± 3.1）, P=0.034]. In F-LCP group, one case had screw perforation, and one with developed avascular necrosis （AVN）. In HA group, one patient developed infection, four patients had shoulder stiffness, and one patient suffered from tuberosity migration. Conclusion The present results show that patients treated by LCP with fibular allograft have better functional outcomes and lower complication rates compared to patients treated by hemiarthroplasty.