锁定钢板内固定术与半肩关节置换术治疗老年人肱骨近端粉碎骨折效果的对照研究

Locking plate for internal fixation vs humeral head prosthesis replacement in treatment of comminuted fracture of proximal humerus in senior patients

摘要:

目的 比较切开复位锁定钢板内固定术和半肩关节置换术治疗老年肱骨近端粉碎骨折的治疗效果。方法 回顾性地分析北京世纪坛医院骨科自2008年1月至2012年12月47例锁定钢板治疗和27例半肩关节置换治疗Neer分型三、四部分肱骨近端骨折患者的手术时间及术中出血量，末次随访的Neer评分情况。结果 随访时间为23.7个月（12～43个月）。内固定组手术时间为（95.4±8.57）min，术中出血量为（277.50±31.65）ml，Neer评分优良率为82.9%；置换组手术时间为（72.60±9.45）min，术中出血量为（287.20±42.51）ml，Neer评分优良率为85.2%。两组手术时间比较差异有统计学意义（P＜0.01），术中出血量及术后随访Neer评分比较差异均无统计学意义（P＞0.05）。结论 锁定加压钢板内固定术与半肩关节置换术都是治疗肱骨近端粉碎骨折的有效方法，术后均能达到满意的临床疗效。对于年龄相对较轻同时可争取术中复位的肱骨近端骨折，锁定钢板内固定是最佳选择；而对于骨折严重粉碎无法重建的肱骨近端骨折，尤其伴有严重骨质疏松的老年患者，半肩关节置换则是最佳选择，应根据不同的骨折损伤情况进行具体选择。

Abstract:

Objective To compare the clinical efficacy of locking plate for internal fixation and humeral head replacement in the treatment of comminuted fractures of the proximal humerus in senior patients. Methods Clinical data of 74 old patients at the age of (76.35±4.78) years with comminuted fractures of the proximal humerus admitted in our department from January 2008 to December 2012 were collected and retrospectively analyzed. Forty-seven patients were treated by locking plate for internal fixation and 27 cases operated with humeral head replacement for 3- and 4-part fractures according to Neer classification system. The 2 groups were compared in the operation time, blood loss and Neer Scores at the end of follow-up. Results The follow-up period was 23.7 months (ranging from 12 to 43 months), which was similar in the 2 groups. The operation time was (95.4±8.57)min in the internal fixation group and (72.60±9.45)min in the replacement group, blood loss was (277.50±31.65)ml and (287.20±42.51)ml, and the rate of excellent and good outcomes by Neer scoring system was 82.9% and 85.2%, respectively, in the 2 groups. The operation time was significantly longer in the internal fixation group than in the replacement group (P＜0.01). But there was no difference in blood loss and Neer score (P＞0.05). Conclusion Both locking plate for internal fixation and humeral head replacement show good efficacy and satisfactory clinical outcomes for comminuted fractures of proximal humerus in the elderly. We suggest that locking plate is suitable to the younger patients who are able to reach intraoperative repositioning. While for the elderly with serious comminuted fractures, especially accompanied with severe osteoporosis, humeral head replacement may be the best option. Surgeons should make individualized management according to the specific fracture condition.