反式肩关节置换与切开复位钢板内固定治疗老年肱骨近端骨折骨不连的效果比较

Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly

背景:老年肱骨近端骨折是老年跌倒损伤常见的疾病,因老年骨质疏松等多种因素治疗后出现骨不连,目前采用反式肩关节置换治疗取得良好的临床疗效,但存在一定的局限性。目的:对比观察反式肩关节置换与切开复位钢板内固定治疗肱骨近端骨折不愈合的临床效果。方法:将120例肱骨近端骨折骨不连患者随机分为观察组和对照组,每组60例。观察组采用反式肩关节置换(人工肩关节假体)治疗,对照组采用切开复位钢板内固定治疗。结果与结论:(1)随访结果:术后3年,观察组疼痛评分低于对照组(P<0.05),Constant日常活动、活动范围、力量测试评分、Constant总分、满意度及住院费用高于对照组,而肩关节前屈、外旋、内旋功能优于对照组(P<0.05);(2)不良反应情况:术后3年,观察组及对照组分别有26及22例患者出现不良反应;(3)结果证实,反式肩关节置换治疗老年肱骨近端骨折骨不连的临床疗效较好,能明显改善患者的疼痛程度和肩关节功能,疗效优于切开复位钢板内固定。

BACKGROUND： Proximal humeral fracture is a common disease of fall injury in the elderly, because of bone nonunion after treatment with a variety of factors such as senile osteoporosis. Currently, the use of reverse total shoulder arthroplasty has achieved good clinical effect, but has certain limitations. OBJECTIVE： To compare and observe the clinical effects of reverse total shoulder arthroplasty and open reduction and internal plate fixation in the treatment of nonunion of proximal humeral fractures. METHODS： Totally 120 cases of nonunion of proximal humeral fractures were randomly divided into observation group and control group, with 60 cases in each group. The observation group received reverse total shoulder arthroplasty （replacement of artificial shoulder joint）. The control group received open reduction and internal plate fixation. RESULTS AND CONCLUSION： （1） Follow-up results： At 3 years after surgery, the pain score was lower in the observation group than that in the control group （P 〈 0.05）. Constant daily activities, range of activities, strength test score, Constant total score, satisfaction and hospitalization expenses were higher in the observation group than in the control group. Functions of flexion, laterotorsion and intorsion were better in the observation group than those in the control group （P 〈 0.05）. （2） Adverse reactions： At 3 years after surgery, 26 and 22 cases had adverse reaction in the observation group and the control group respectively. （3） The results show that the clinical effect of the elders＇ nonunion of proximal humeral fracture treated with reverse total shoulder arthroplasty is quite good, and the pain degree and shoulder function are obviously improved. The curative effect of reverse total shoulder arthroplasty is better than that of open reduction and internal plate fixation.