半肩关节置换术与肱骨近端锁定钢板内固定对肱骨近端Ⅲ、Ⅳ型骨折患者的疗效

Effect of Hemi-Shoulder Arthroplasty and Locking Proximal Humeral Plate Internal Fixation in Patients with TypeⅢandⅣProximal Humerus Fractures

目的探讨半肩关节置换术(HA)与肱骨近端锁定钢板(LPHP)内固定治疗Ⅲ、Ⅳ型肱骨近端骨折(PHF)患者的效果。方法选取2018年1月至2020年12月焦作煤业(集团)有限责任公司中央医院收治的88例Ⅲ、Ⅳ型PHF患者作为研究对象,根据随机数字表法分为HA组(44例)和LPHP内固定组(44例)。LPHP内固定组接受LPHP内固定治疗,HA组接受HA治疗。比较两组手术效果、围手术期指标(术中失血量、手术时长)、术后康复情况(肿胀消退时间、住院时间、骨痂出现时间及骨折愈合时间),比较术前及术后1、3个月的肩关节功能评分、Neer评分以及两组术后并发症发生率。结果HA组优良率[97.73%(43/44)]较LPHP内固定组[79.55%(35/44)]高(P<0.05);HA组术中失血量较LPHP内固定组少,手术时间、肿胀消退时间、住院时间、骨痂出现时间及骨折愈合时间较LPHP内固定组短(P<0.05);HA组术后1、3个月肩关节功能评分、Neer评分较LPHP内固定组高(P<0.05);HA组并发症总发生率[4.55%(2/44)]较LPHP内固定组[20.45%(9/44)]低(P<0.05)。结论与LPHP内固定治疗相比,HA治疗Ⅲ、Ⅳ型PHF患者可提高手术效果,优化围手术期指标,在改善肩关节功能、促进术后康复方面更具优势,且安全性更高。

Objective To explore the effect of hemi-shoulder arthroplasty(HA)and locking proximal humerus plate(LPHP)internal fixation in the treatment of typeⅢandⅣproximal humeral fracture(PHF)patients.Methods A total of 88 patients with typeⅢandⅣPHF in Central Hospital of Jiaozuo Coal Industry(Group)Company Limited from January 2018 to December 2020 were selected as the research objects,and they were divided into HA group(44 cases)and LPHP internal fixation group(44 cases)according to the random number table method.The LPHP internal fixation group received LPHP internal fixation treatment,and the HA group received HA treatment.The operation effect,perioperative indexes(intraoperative blood loss,operation duration)and postoperative rehabilitation(swelling regression time,hospital stay,callus appearance time and fracture healing time)were compared,and the shoulder function score and Neer score before and 1 and 3 months after operation and postoperative complication rate of two groups were compared.Results The excellent and good rate of HA group[97.73%(43/44)]was higher than that[79.55%(35/44)]of LPHP internal fixation group(P<0.05).The intraoperative blood loss in HA group was less than that in LPHP internal fixation group,and the operation time,swelling regression time,hospital stay,callus appearance time and fracture healing time in HA group were shorter than those in LPHP internal fixation group(P<0.05).The shoulder function score and Neer score in HA group were higher than those in LPHP internal fixation group at 1 and 3 months after operation(P<0.05).The total incidence of complications in HA group[4.55%(2/44)]was lower than that[20.45%(9/44)]in LPHP internal fixation group(P<0.05).Conclusion Compared with LPHP internal fixation,HA can improve the surgical effect of patients with typeⅢandⅣPHF,optimize perioperative indicators,and has more advantages in improving shoulder function and promoting postoperative rehabilitation and have higher safety.