人工肱骨头置换治疗肱骨近端粉碎骨折的临床疗效

Clinical effect of artificial humeral head replacement in the treatment of comminuted proximal humeral fractures

目的探究人工肱骨头置换治疗肱骨近端粉碎骨折的临床疗效。方法选取2019年6月至2020年6月本院收治的48例肱骨近端粉碎骨折患者作为研究对象,按照随机数字表法分为对照组和观察组,各24例。对照组行肱骨近端锁定钢板内固定(LPHP)治疗,观察组行人工肱骨头置换治疗,比较两组围手术期指标、临床疗效、Neer肩关节功能评分及并发症发生率。结果观察组手术时间长于对照组,术中出血量多于对照组,差异有统计学意义(P<0.05);两组骨折愈合时间、住院时间比较差异无统计学意义。术后12个月,观察组优良率为83.33%,对照组优良率为79.17%,两组优良率比较差异无统计学意义。术后6个月,观察组疼痛评分、日常生活评分、活动范围评分、总分均高于对照组,差异有统计学意义(P<0.05);术后12个月,两组疼痛评分、日常生活评分、活动范围评分及总分均高于术后6个月,但组间比较差异无统计学意义。两组并发症发生率比较差异无统计学意义。结论LPHP与人工肱骨头置换均为治疗肱骨近端粉碎骨折的有效术式,LPHP可减少骨折愈合时间,人工肱骨头置换有利于患者术后早期肩关节功能恢复,应结合患者实际情况选取适宜术式。

Objective To explore the clinical effect of artificial humeral head replacement in the treatment of comminuted proximal humeral fractures.Methods 48 patients with comminuted proximal humeral fractures admitted to our hospital from June 2019 to June 2020 were selected as the study subjects,the they were divided into control group and observation group according to random number table method,with 24 cases in each group.The control group received locking proximal humerus plate(LPHP),and the observation group received artificial humeral head replacement,the perioperative indexes,clinical efficacy,Neer shoulder joint function score and the incidence of complication rate between the two groups were compared.Results The operation time in the observation group was longer than that in the control group,and the intraoperative blood flow was more than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the time of fracture healing and hospitalization between the two groups.12 months after operation,the excellent and good rate was 83.33%in the observation group and 79.17%in the control group,there was no significant difference between the two groups.6 months after operation,the pain score,daily life score,range of activity score and total score in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05);12 months after operation,the of pain score,daily life score,activity range score and total score of the two groups were higher than those at 6 months after operation,but there was no significant difference between the two groups.There was no significant difference in the incidence of complications between the two groups.Conclusion LPHP and artificial humeral head replacement are both effective surgical methods for the treatment of comminuted proximal humeral fractures,LPHP can reduce the fracture healing time.Artificial humeral head replacement is conducive to the early recovery of shoulder joint function after surgery,appropriate surgical methods should be selected according to the actual situation of patients.