人工肱骨头置换治疗老年肱骨近端复杂性骨折的临床效果评价

Clinical Evaluation of Artificial Humeral Head Replacement for the Treatment of Complicated Proximal Humeral Fractures in the Elderly

目的探讨老年肱骨近端复杂性骨折应用人工肱骨头置换方案治疗手术质量及预后康复效果。方法选择老年肱骨近端复杂性骨折患者100例,均为该院骨科2017年2月-2018年2月收治,随机分组,就采用人工肱骨头置换方案治疗(观察组,n=50)与采用肱骨近端锁定钢板治疗(观察组,n=50)手术实施情况、肩关节功能恢复状况、并发症率展开对比。结果观察组手术操作用时、实际出血量、术后引流量、平均住院天数均少于对照组(P<0.05)。观察组术后肩关节功能肌力、疼痛、活动范围、日常生活活动水平各维度评分、总分均高于对照组,差异有统计学意义(P<0.05)。观察组术后仅感染、关节僵硬各1例,并发症率为4%;对照组感染2例,异位骨化1例,关节僵硬2例,肱骨头缺血坏死4例,并发症率为18%,差异有统计学意义(χ^2=7.111,P<0.05)。结论老年肱骨近端复杂性骨折应用人工肱骨头置换方案治疗,可获取理想的手术质量,改善肩关节功能,且具更高安全性,值得临床广泛推广应用,以在增强治疗效果的同时,为患者生存质量的改善提供保障,并进一步维护医院、社会权益。

Objective To investigate the effect of artificial humeral head replacement on the quality and prognosis of senile proximal humeral fractures. Methods One hundred patients with complicated fractures of the proximal humerus were selected. All of them were admitted to our department of orthopedics from February 2017 to February 2018. By randomized grouping, they were divided into observation group (n=50, treated with artificial radial head replacement) and control group (n=50, treated with humerus proximal locking plate). The recovery of shoulder function and the complication rate were compared. Results The operation time, actual bleeding volume, postoperative drainage volume, and average length of hospital stay in the observation group were less than those in the control group (P<0.05). In the observation group, the scores of the shoulder muscle function, pain, activity range, and activities of daily living were all higher than those of the control group, and the difference was statistically significant (P<0.05). In the observation group, only one case of infection and joint stiffness was observed, and the complication rate was 4%. In the control group, 2 cases were infected, and there was 1 case of heterotopic ossification, 2 cases of joint stiffness, 4 cases of ischemic necrosis of the humeral head. And the complication rate was 18%, and the difference was statistically significant (χ^2=7.111, P<0.05). Conclusion The treatment of artificial humeral head replacement in the patients with proximal humeral complex fractures can achieve ideal surgical quality. It improves shoulder function, and is safer. It is worthy of widespread application in clinical practice to enhance the therapeutic effect, provide protection for the improvement of patients' quality of life and further protect hospital and social rights.