半肩关节置换术治疗肱骨近端复杂骨折的效果分析

Curative effect analysis of hemi arthroplasty of the shoulder for the treatment of complex proximal humeral fractures

目的比较半肩关节置换术与切开复位内固定术治疗肱骨近端复杂骨折的临床效果,为临床术式选择提供参考。方法回顾性分析2012年2月至2018年10月在陆军军医大学第一附属医院诊断为肱骨近端复杂骨折的50例患者的临床资料,按术式的不同分为切开复位内固定组28例(内固定组)与半肩关节置换组22例(置换组)。比较2组患者手术时间和肩关节前屈、外展、外旋及内旋角度,采用ASES、UCLA、SST、VAS评价2种术式的肩关节功能,分析手术并发症。结果置换组患者手术时间和出血量均少于内固定组,差异有统计学意义(P<0.05);术后1年,置换组与内固定组的前屈、外展、外旋及内旋角度分别为(108.37±12.16)°、(96.58±9.09)°、(33.42±3.89)°、(57.21±6.69)°与(95.24±10.32)°、(85.54±8.47)°、(28.35±3.77)°、(48.79±3.53)°,置换组患者各功能活动角度明显高于内固定组;ASES、UCLA、SST、VAS优于内固定组;置换组患者的并发症发生率也低于内固定组,差异均有统计学意义(P<0.05)。结论与切开复位内固定术比较,半肩关节置换术治疗肱骨近端复杂骨折的手术时间更短、手术创伤更小,术后肩关节功能活动度恢复满意,并发症发生率低,具有更好的临床治疗效果。

Objective To compare the clinical effects of hemi arthroplasty of the shoulder and open reduction and internal fixation in the treatment of complex proximal humeral fractures,and to provide a reference for the selection of clinical surgical methods.Methods The clinical data of 50 patients diagnosed as complex proximal humerus fractures in the first affiliated hospital of the Army Medical University from February 2012 to October 2018 were retrospectively analyzed.According to different surgical methods,the patients were divided into the open reduction and internal fixation group(internal fixation group,28 cases)and the hemihumeral joint replacement group(replacement group,22 cases).The operation time,forward flexion,abduction,outward rotation and inward rotation angles of the shoulder joint in the two groups were compared,and the shoulder joint functions of the two surgical methods were evaluated by ASES,UCLA,SST and VAS scores,and the surgical complications were analyzed.Results The operation time and blood loss in the replacement group were less than those in the internal fixation group with statistically significant difference(P<0.05).One year after surgery,the angles of anterior flexion,abduction,external rotation and internal rotation in the replacement group and the internal fixation group were(108.37±12.16)°,(96.58±9.09)°,(33.42±3.89)°,(57.21±6.69)°and(95.24±10.32)°,(85.54±8.47)°,(28.35±3.77)°,(48.79±3.53)°,respectively.The angle of functional activity in the replacement group was significantly higher than that in the internal fixation group(P<0.05).ASES,UCLA,SST and VAS scores of the replacement group were better than those of the internal fixation group(P<0.05).The incidence of complications in the replacement group was also lower than that in the internal fixation group(P<0.05).Conclusion Compared with open reduction and fixation,hemihumeral joint replacement for complex proximal humeral fractures has a shorter operation time,less surgical trauma,more satisfied recovery of functional range of shoulder joint,lower incidence of complications,and better clinical treatment effect.