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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期数:

2013年01期

页码:

26-29

栏目:

关节置换

出版日期:

2013-01-20

文章信息/Info

Title:

A retrospective trial of open reduction and locking plate internal fixation versus hemiarthroplasty for comminuted proximal humeral fractures in old patients

作者:

何帮剑¹; 金红婷²; 吕一¹; 季四青¹; 周国庆¹; 童培建³

1.浙江中医药大学附属第三医院,浙江 杭州 310005;
2.浙江中医药大学, 浙江 杭州 310053;
3.浙江中医药大学附属第一医院,浙江 杭州 310006

Author(s):

HE Bang-jian^*; JIN Hong-ting; LV Yi; JI Si-qing; ZHOU Guo-qing; TONG Pei-jian

^*The Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310005,Zhejiang,China

关键词:

肩骨折 肱骨骨折 骨折固定术; 内 骨板 关节成形术; 置换 治疗; 临床研究性

Keywords:

Shoulder fractures;  Humeral fractures;  Fracture fixation; internal;  Bone plates;  Arthroplasty; replacement;  Therapies; investigational

摘要:

目的:比较切开复位锁定钢板内固定和人工肱骨头置换治疗高龄肱骨近端骨折的临床疗效和安全性。方法:回顾性分析接受手术治疗的50例高龄肱骨近端粉碎性骨折患者的病历资料,采用切开复位锁定钢板内固定治疗者23例(A组),采用人工肱骨头置换治疗者27例(B组)。比较2组患者的手术时间、术中出血量、术后引流量及住院时间,比较2组患者末次随访时的Constant-Murley肩关节评分,同时比较患者术后及随访期间的并发症发生情况。结果:①一般情况。B组患者的手术时间[(70.74±10.16)min]、术中出血量[(192.96±50.29)mL]、术后引流量[(52.78±10.59)mL]及住院时间[(9.78±2.14)d]均少于A组[(92.17±11.66)min,(242.61±63.48)mL,(74.35±20.91)mL,(14.22±4.30)d],差异均有统计学意义(t=6.946,P=0.000; t=3.085,P=0.003; t=4.705,P=0.000; t=4.733,P=0.000)。②Constant-Murley评分。2组患者的肩关节疼痛[(12.65±1.92)分,(13.19±1.59)分]、日常生活能力[(15.73±2.20)分,(15.93±2.25)分]、肩关节活动度[(28.70±7.71)分,(30.59±7.72)分]、上肢肌力评分[(13.48±3.37)分,(13.30±3.18)分]及Constant-Murley总分[(70.57±9.31)分,(73.00±7.61)分]比较,差异均无统计学意义(t=-1.072,P=0.289; t=-0.295,P=0.769; t=-0.866,P=0.391; t=0.196,P=0.845; t=-1.018,P=0.314)。③安全性。2组患者均获随访,随访时间24～72个月,中位数51.5个月。A组1例患者出现肩关节僵硬,1例发生肱骨头无菌性坏死,未发生内固定断裂或松动等并发症; B组1例患者出现关节不稳,未发生假体松动、假体周围骨折及血管神经损伤等并发症。2组患者并发症发生情况比较,差异无统计学意义(χ2=0.021,P=0.886)。结论:切开复位锁定钢板内固定和人工肱骨头置换治疗高龄肱骨近端粉碎性骨折的疗效和安全性相当,但后者具有手术时间短、出血量少、术后引流量少及住院时间短的优势。因此,对于高龄肱骨近端粉碎性骨折,尤其是合并重度骨质疏松者,建议采用人工肱骨头置换术治疗。

Abstract:

Objective:To compare open reduction and locking plate internal fixation with hemiarthroplasty in the clinical curative effects and safety for comminuted proximal humeral fractures in old patients.Methods:The medical records of 50 old patients who underwent operative treatment for comminuted proximal humeral fractures were analyzed retrospectively.Twenty-three patients(group A)were administrated with open reduction and locking plate internal fixation,while the others(group B)were administrated with hemiarthroplasty.The two groups were compared with each other in such parameters as operative time,blood loss,postoperative drainage,hospital stay,Constant-Murley shoulder scores at last follow-up,and complications during postoperative period and follow-up period.Results:The operative time((70.74±10.16)min),blood loss((192.96±50.29)ml),postoperative drainage((52.78±10.59)ml)and hospital stay((9.78±2.14)d)of group B were all lower than those of group A((92.17±11.66)min,(242.61±63.48)ml,(74.35±20.91)ml,(14.22±4.30)d)respectively,and there were statistical differences between the 2 groups(t=6.946,P=0.000; t=3.085,P=0.003; t=4.705,P=0.000; t=4.733,P=0.000).There were no statistical differences in the following scores of shoulder pain((12.65±1.92),(13.19±1.59)),activities of daily living((15.73±2.20),(15.93±2.25)),range of motion of shoulder((28.70±7.71),(30.59±7.72)),muscle power of upper limb((13.48±3.37),(13.30±3.18))and Constant-Murley total scores((70.57±9.31),(73.00±7.61))between the 2 groups respectively(t=-1.072,P=0.289; t=-0.295,P=0.769; t=-0.866,P=0.391; t=0.196,P=0.845; t=-1.018,P=0.314).The patients in the 2 groups were all followed up for 24-72 months with a median of 51.5 months.One patient with shoulder stiffness and 1 patient with aseptic necrosis of head of humerus were found in group A,while no complications such as break or loosening of internal fixations were found.One patient with instability of shoulder joint was found in group B,while no complications such as loosening of the prosthesis,peri-prosthetic fracture and neurovascular injury were found.There were no statistical differences in incidence rate of complications between the 2 groups(χ2=0.021,P=0.886).Conclusion:The therapy of open reduction and locking plate internal fixation is similar to hemiarthroplasty in the curative effect and safety for comminuted proximal humeral fractures in old patients,while the latter has such advantages as shorter operative time,less blood loss less amounts of postoperative drainage and shorter hospital stay.Therefore,we suggest that the hemiarthroplasty should be applied in the treatment of comminuted proximal humeral fractures in old patients,especially for those with severe osteoporosis.

备注/Memo

备注/Memo:

通讯作者:童培建 E-mail:tongpeijian@163.com

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更新日期/Last Update: 2013-01-20