人工肱骨头假体置换与肱骨近端锁定钢板固定治疗老年Neer三、四部分肱骨近端骨折

Comparison of Artificial Humeral Head Replacement and Locking Proximal Humerus Plate Fixation in Treatment of Senile Neer Three or Four-part Proximal Humeral Fracture

目的比较人工肱骨头假体置换与肱骨近端锁定钢板固定治疗老年Neer三、四部分肱骨近端骨折的临床疗效。方法回顾性分析2014年2月至2016年3月云南省第二人民医院骨与创伤外科收治的60岁以上老年Neer三、四部分肱骨近端骨折患者70例的临床资料,根据治疗方式分为置换组和内固定组,分别为32例、38例。比较2组临床疗效、手术相关指标、住院时间、术后Neer评分、术后Constant-Murley肩关节功能评分、治疗前后生活质量评分及并发症发生率。结果置换组手术时间、术中出血量、手术优良率、术后Neer评分与内固定组相比,差异无统计学意义(P>0.05);置换组Constant-Murley肩关节功能评分较内固定组明显更高,差异具有统计学意义(P<0.05);与治疗前相比,置换组和内固定组生活质量评分在治疗后均明显上升,且置换组上升幅度更大,差异具有统计学意义(P<0.05);置换组并发症发生率较内固定组明显更低,差异具有统计学意义(P<0.05)。结论人工肱骨头假体置换与肱骨近端锁定钢板固定均可有效治疗老年Neer三、四部分肱骨近端骨折,但人工肱骨头假体置换术后并发症少,患者肩关节恢复好,生活质量高。

Objective To compare the clinical efficacy of artificial humeral head replacement and locking proximal humerus plate fixation in treatment of senile Neer three or four-part proximal humeral fracture.Methods The clinical data of 70 patients aged over 60 with Neer three or four-part proximal humeral fracture in the Orthopedics and Trauma Department of Yunnan Second People's Hospital from February 2014 to March 2016 were retrospectively analyzed.All the patients were divided into 32 cases of replacement group and 38 cases of internal fixation group by treatment methods.The clinical efficacy,surgical indexes,hospital stays,postoperative Neer score,postoperative Constant-Murley shoulder joint score,scores of living quality before and after treatment,incidence of complications were compared between the two groups.Results There was no statistical difference in the operation time,intraoperative bleeding volume,excellent rate of surgery,postoperative Neer score in replacement group (P > 0.05);The Constant-Murley shoulder joint score in replacement group was higher than that in internal fixation group (P < 0.05);Compared with before treatment,the scores of living quality in two groups increased after treatment,and the increased range of replacement group was larger than that of internal fixation group (P < 0.05). The incidence of complications in replacement group was lower than that in internal fixation group (P < 0.05).Conclusion Artificial humeral head replacement and locking proximal humerus plate fixation in treatment of senile Neer three or four-part proximal humeral fracture are effective,but artificial humeral head replacement has less postoperative complications,better recovery of shoulder joint and higher living quality.