半肩关节置换治疗高龄肱骨近端四部分骨折的疗效评价

Efficacy Evaluation of Shoulder Hemiarthroplasty for Neer Four⁃Part Proximal Humeral Fractures in the Elderly

目的评估半肩关节置换治疗高龄肱骨近端四部分骨折的疗效。方法回顾性分析2018年1月至2021年12月采用半肩关节置换手术治疗的21例高龄肱骨近端四部分骨折的病人资料,其中男4例,女17例,平均年龄76岁(65~89岁);均为闭合性新鲜骨折;受伤至手术时间平均为5天(3~8天)。采用疼痛视觉模拟量表(VAS)和Constant-Murley肩关节评分评价手术疗效。结果21例病人切口均一期愈合。所有病人随访时间超过6个月,其中11例病人随访超过24个月,平均随访时间20个月(6~48个月)。21例病人肱骨大、小结节均愈合。术后6个月,21例病人的VAS评分为(1.24±1.22)分;Constant Murley评分为(81.10±7.16)分,末次随访时进一步提高为(88.45±4.57)分。进一步研究发现,75岁以上病人术后6个月的VAS评分显著低于75岁以下病人[(0.73±0.90)分vs.(1.80±1.32)分],Constant-Murley评分也显著低于75岁以下病人[(78.00±6.83)分vs.(84.50±6.13)分],差异均有统计学意义(P<0.05)。结论半肩关节置换治疗高龄肱骨近端四部分骨折的疗效优良。

Objective To evaluate the efficacy of shoulder hemiarthroplasty for the treatment of Neer four⁃part proximal humeral fractures in the elderly.Methods The data of 21 elderly patients with four⁃part proximal humeral fractures who underwent shoulder hemiarthroplasty from January 2018 to December 2021 were retrospectively analyzed,including 4 males and 17 females,with an average age of 76 years(65⁃89).All fractures were fresh and close which caused by trauma.The time from injury to surgery was 5 days(3⁃8 days).Visual analogue scale(VAS)and Constant⁃Murley shoulder score were used to evaluate the postoperative efficacy.Results All the 21 patients had primary healing.All patients were followed up for more than 6 months,and 11 patients were followed up for more than 24 months,with a mean follow⁃up period of 20 months(6⁃48 months).Both large and small humeral nodules healed in 21 patients.At 6th month after surgery,the VAS score of 21 patients was 1.24±1.22;The Constant⁃Murley score was 81.10±7.16,which was further improved to 88.45±4.57 at the last follow⁃up.Further research found that patients over 75 years old had significantly lower VAS scores at 6th month after surgery than those under 75 years old(0.73±0.90 vs.1.80±1.32),and the Constant⁃Murley score was also significantly lower in patients over 75 years than those under 75 years old(78.00±6.83 vs.84.50±6.13),with statistically significant differences(P<0.05).Conclusion Shoulder hemiarthroplasty is effective in treating Neer four⁃part proximal humeral fractures in elderly patients.