老年肱骨近端粉碎骨折肱骨头置换及锁定钢板固定术治疗的疗效对比

Clinical comparative study of humeral head fracture replacement and locking plate fixation in the treatment of proximal humerus comminuted fracture

目的通过对老年肱骨近端NeerⅢ型、Ⅳ型骨折采用肱骨头置换及锁定钢板固定的疗效对比,指导临床选择更合理的手术方案。方法我科2012年至2016年采用人工肱骨头置换及肱骨近端解剖锁定钢板固定的63例肱骨近端粉碎(NeerⅢ型、Ⅳ型)骨折患者,随访12~48个月,平均随访29个月。结果两组患者在手术用时、术中的出血量、术后的引流量、切口愈合时间比较上差异无统计学意义,P>0.05。两组患者术后(6周、12周)Neer评分比较均p<0.05,有统计学意义;两组患者术后(6月、9月、12月)Neer评分比较P>0.05,差异无统计学意义。肱骨头置换术优良率为82.7%,锁定钢板固定组优良率为85.3%,两组数据比较差异无统计学意义(P>0.05)。切开复位锁定钢板内固定组术后发生骨折移位后畸形愈合1例,患者耐受良好,骨折不愈合1例。肱骨头置换组发生腋神经损伤1例,术后经消肿及营养神经等药物应用4月后康复。发生脑血管意外1例,转神经内科治疗。结论两种治疗方法均可获得较满意的早期临床效果,锁定接骨板固定术远期效果相对优于置换组。

Objective To compare the clinical efficacy of humeral head replacement and locking plate fixation in elderly patients with proximal humeral fractures of Neer,Ⅲ and Ⅳ,so as to guide the selection of more reasonable surgical procedures. Methods63 patients with proximal humeral fractures（ Neer,Ⅲ and Ⅳ） fractures were treated with artificial humeral head replacement and proximal humerus anatomical locking plate in 2012 - 2016 years. The patients were followed up for 12 - 48 months with an average follow-up of 29 months. Results There was no statistical difference between the two groups in the time of operation,the amount of bleeding during operation,the amount of drainage and the healing time of P〉0. 05. Two groups of patients after operation（ 6 weeks,12 weeks） Neer score,P〈0. 05,there was statistical significance; two groups of patients after surgery（ June,September and December） Neer score,P〈0. 05,the difference was not statistically significant. Humeral head replacement for the excellent rate of82. 7%,the locking plate fixation group the excellent rate was 85. 3%,there was no significant difference between the two groups of data（ P〉0. 05）; open reduction and locking plate fixation group after displaced deformity after fracture healed in 1 cases,the patients were well tolerated,1 cases of nonunion,. There were 1 cases of axillary nerve injury in the humeral head replacement group,1 cases of cerebrovascular accident were recovered after the application of detumescence and neurotrophic nerve drugs in April,and they were transferred to the neurology department for treatment. Conclusion The one or two treatment methods can obtain satisfactory early clinical results. Two. The long-term effect of locking plate fixation is better than that of the replacement group.