老年肱骨近端粉碎性骨折人工肱骨头置换与锁定加压钢板固定的对比

Artificial humeral head replacement versus locking proximal humerus plate for proximal humeral comminuted fractures in the elderly

[目的]对比老年肱骨近端粉碎性骨折实施人工肱骨头置换与锁定加压钢板内固定的临床效果。[方法]回顾性分析2014年1月~2016年12月收治的60例老年肱骨近端粉碎性骨折患者的临床资料,其中32例实施人工肱骨头置换手术(置换组);28例采用锁定加压钢板内固定(内固定组)。对比术中出血量、手术时间、住院时间、切口愈合情况、Constant-Murley肩关节功能评分、术后并发症情况和患者的满意度。[结果]所有患者均顺利手术,无血管神经损伤等严重并发症。置换组术中出血量、手术时间、住院时间均显著少于内固定组,差异均有统计学意义(P<0.05)。置换组切口愈合稍优于内固定组,但差异无统计学意义(P>0.05)。所有患者术后随访12~24个月,平均(18.73±2.04)个月。置换组术后6个月Constant-Murley肩关节功能量表的活动范围评分和总分均高于内固定组,差异有统计学意义(P<0.05)。置换组与内固定组并发症发生率分别为0.00%、14.29%,两组差异有统计学意义(P<0.05)。置换组和内固定组总满意率分别为96.88%、78.57%,两组差异有统计学意义(P<0.05)。在≥80岁的患者中,置换组与内固定组总满意率分别为100.00%、66.67%,差异均有统计学意义(P<0.05)。而在<80岁的患者中,两组的总满意率差异无统计学意义(P>0.05)。[结论]人工肱骨头置换治疗老年肱骨近端粉碎性骨折创伤小、恢复快,相较于LPHP能够显著改善肩关节活动范围和功能,安全性高,且还可提升患者满意度,尤其是高龄患者。

[Objective] To compare the clinical outcomes of artificial humeral head replacement（AHHR） versus locking proximal humerus plate（LPHP） for proximal humeral comminuted fractures in elderly. [Methods] A retrospective study was conducted on 60 elderly patients who underwent surgical treatment for comminuted fractures of proximal humerus from January2014 to December 2016. Among them, 32 patients underwent AHHR, while the remaining 28 patients had the fractures internally fixed with LPHP. The bleeding, operation time, hospital stay, incision healing, shoulder joint function score and postoperative complications and patient.s satisfaction were compared between them. [Results] All the patients had operation performed smoothly without serious intraoperative complication, such as neurovascular injuries. The AHHR group took significantly less intraoperative blood loss, shorter operation time and hospital stay than the LPHP group with statistical differences between them（P〈0.05）. The AHHR group got slightly better incision healing than the LPHP group although no a statistical difference existed between the two groups（P〉0.05）. All patients were followed up for 12 to 24 months with an average of（18.73±2.04） months. At 6 months postoperatively, the AHHR proved significantly superior to the LPHP in the mobility score and the total score of Constant-Murley score（P〈0.05）. The AHHR group had significantly less complication than the LPHP（0.00% versus 14.29%, P〈0.05）. At the latest follow up, the AHHR group also was significantly superior to the LPHP regarding to patient.s satisfaction in the total ratio [96.88% versus 78.57%, P〈0.05] and the patients equal or more than 80 years [100.00% versus66.67%, P〈0.05], despite the fact that no a statistical difference was noted between them in the patients less than 80 years（P〉0.05）. [Conclusion] Artificial humeral head replacement takes advantages of minimalized trauma, faster functional recovery,and improved range of motion, as well as high safety and patient.s satisfaction over the internal fixation with locking proximal humerus plate for proximal humeral comminuted fractures, especially in the elderly.