切开复位锁定板固定与人工肱骨头置换治疗老年肱骨近端骨折的应用效果观察

Observation on application effects of open reduction and locking plate fixation and artificial humeral head replacement for senile proximal humeral fractures

目的观察切开复位锁定板固定与人工肱骨头置换(HHR)治疗老年肱骨近端骨折(PHF)的应用效果。方法将2017年1～12月收治的104例老年PHF患者作为研究对象,按随机数字表分为两组。对照组52例接受切开复位锁定板固定治疗,观察组52例实施HHR治疗。观察两组术中出血量、手术时间,手术前后肩关节功能、疼痛评分及术后并发症等。结果观察组术中出血量少于对照组,手术时间短于对照组,比较差异有统计学意义(P<0.01)。术前两组Constant评分、VAS评分、EQ-5D评分指数对比,差异无统计学意义(P> 0.05);术后两组Constant评分、VAS评分、EQ-5D评分指数均显著改善(P<0.01),观察组Constant评分高于对照组,VAS评分、EQ-5D评分指数低于对照组,比较差异有统计学意义(P<0.01)。观察组并发症发生率为7.69%(4/52),对照组并发症发生率为3.85%(2/52),两组并发症发生率相比,差异无统计学意义(χ2=0.177,P=0.400)。结论 HHR治疗老年PHF具有创伤小、并发症少等特点,利于快速缓解患者疼痛,加快肩关节功能恢复,提升患者生活质量。

Objective To observe the application effects of open reduction and locking plate fixation and artificial humeral head replacement(HHR)in the treatment of senile proximal humeral fractures(PHF).Methods 104 senile patients with PHF treated in the hospital from January to December 2017 were selected,and they were divided into two groups by random number table,with 52 cases in each group.Control group were given open reduction and locking plate fixation,while observation group were treated with artificial HHR.And then,intraoperative bleeding volume,operation time as well as shoulder joint functions,pain scores before and after treatment and complications were observed between the two groups.Results Intraoperative bleeding volume in the observation group was less,and operation time was shorter than that in the control group,difference was statistically significant(P<0.01).Before operation,there was no statistically significant difference in the Constant scores,visual analogue scales(VAS)and European quality of life 5-dimensions(EQ-5D)score indexes between the two groups(P>0.05).After operation,however,Constant scores,VAS scores and EQ-5D score indexes of the two groups all significantly improved(P<0.01),and compared with the control group,the Constant score of the observation group was higher,the VAS and EQ-5D score index of observation group were lower,difference was statistically significant(P<0.01).The incidence of complications was 7.69%(4/52)in the observation group and 3.85%(2/52)in the control group,and there was no statistically significant difference in the incidence of complications between the two groups(χ2=0.177,P=0.400).Conclusion HHR has the characteristics of less trauma and complications in the treatment of senile PHF,it can quickly relieve patients’pain,accelerate recovery of shoulder joint function,and improve patients’living quality.