[1]柴浩,张磊,孙荣鑫.半关节成形术和反式肩关节置换术治疗老年肱骨近端Neer三、四部分骨折的对比研究[J].中医正骨,2017,29(07):21-26.
　CHAI Hao,ZHANG Lei,SUN Rongxin.A comparative study of hemiarthroplasty versus reverse shoulder arthroplasty for treatment of Neer 3-part and 4-part proximal humeral fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(07):21-26.
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半关节成形术和反式肩关节置换术治疗老年肱骨近端Neer三、四部分骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年07期
页码:
21-26
栏目:
临床研究
出版日期:
2017-07-20

文章信息/Info

Title:
A comparative study of hemiarthroplasty versus reverse shoulder arthroplasty for treatment of Neer 3-part and 4-part proximal humeral fractures in the aged
作者:
柴浩1; 张磊2; 孙荣鑫1
1.新疆医科大学第六附属医院,新疆 乌鲁木齐 830002; 2.中国人民武装警察部队新疆生产建设兵团指挥部医院,新疆 乌鲁木齐 830063
Author(s):
CHAI Hao1; ZHANG Lei2; SUN Rongxin1
1.The Sixth Affiliated Hospital of Xinjiang Medical University,Urumchi 830002,Xinjiang,China 2.The Command Post Hospital Affiliated to Xinjiang Production and Construction Corps of Chinese People's Armed Police Forces,Urumchi 830063,Xinjiang,China
关键词:
肩骨折;  肱骨骨折;  反式肩关节置换术;  半关节成形术;  老年人
Keywords:
Key words shoulder fractures;  humeral fractures;  reverse shoulder arthroplasty;  hemiarthroplasty;  aged
摘要:
目的:比较半关节成形术(hemiarthroplasty,HA)和反式肩关节置换术(reverse shoulder arthroplasty,RSA)治疗老年肱骨近端Neer三、四部分骨折的临床疗效和安全性。方法:回顾性分析82例老年肱骨近端Neer三、四部分骨折患者的病例资料,其中采用RSA治疗44例,采用HA治疗38例; 男51例,女31例; 年龄65～75岁,中位数70岁; 左侧45例,右侧37例; 按照肱骨近端骨折的Neer分型,三部分骨折57例、四部分骨折25例。比较2组患者的手术时间、术中出血量、骨折愈合时间和并发症发生情况,比较2组患者的术前、术后12个月肩关节Neer评分以及术后4周、8周、12周欧洲五维健康量表(EuroQol-5 dimensions,EQ-5D)评分,并根据术后12个月的肩关节Neer评分评价综合疗效。结果:①一般指标。RSA组手术时间长于HA组[(121.41±12.43)min,(101.32±17.51)min,t=6.050,P=0.001)],术中出血量多于HA组[(650.13±28.41)mL,(581.41±30.20)mL,t=10.608,P=0.000]; 2组患者骨折愈合时间比较,差异无统计学意义[(15.42±2.10)周,(15.30±3.17)周,t=0.205,P=0.153]。②肩关节Neer评分。2组患者术前肩关节Neer评分比较,差异无统计学意义[(50.41±5.22)分,(49.82±4.70)分,t=0.534,P=0.316]; 术后12个月,RSA组肩关节Neer评分高于HA组[(80.40±4.11)分,(71.53±3.42)分,t=10.522,P=0.002],2组患者肩关节Neer评分均较术前升高(t=30.212,P=0.001; t=23.024,P=0.001)。③EQ-5D评分。术后不同时间点间EQ-5D评分的差异有统计学意义,即存在时间效应(F=18.760,P=0.001); 2组患者EQ-5D评分总体比较,组间差异有统计学意义,即存在分组效应(F=2.811,P=0.036); 术后4周、术后8周,RSA组EQ-5D评分高于HA组[(0.52±0.07)分,(0.45±0.08)分,t=4.226,P=0.044;(0.61±0.07)分,(0.54±0.09)分,t=3.957,P=0.017]; 术后12周2组患者EQ-5D评分比较,组间差异无统计学意义[(0.68±0.08)分,(0.65±0.06)分,t=1.896,P=0.108]; 时间因素与分组因素存在交互效应(F=7.022,P=0.023)。④综合疗效。RSA组优22例、良15例、可5例、差2例,HA组优13例、良11例、可9例、差5例; RSA组综合疗效优于HA组(Z=-1.997,P=0.046)。⑤安全性。RSA组术后发生关节僵硬1例、肩峰撞击征1例,HA组术后发生关节僵硬4例、肩峰撞击征5例,RSA组并发症发生率低于HA组(χ2=6.430,P=0.011)。结论:对于老年肱骨近端Neer三、四部分骨折患者而言,虽然RSA术比HA术的手术时间长、术中出血量多,且二者在骨折愈合时间方面无明显差异; 但与HA术相比,采用RSA术能快速改善患者生活质量,且综合疗效和安全性均优于HA术,是治疗老年肱骨近端Neer三、四部分骨折的一种较理想的方法,值得临床推广应用。
Abstract:
ABSTRACT Objective:To compare the clinical curative effects and safety of hemiarthroplasty(HA)versus reverse shoulder arthroplasty(RSA)for the treatment of Neer 3-part and 4-part proximal humeral fractures in the aged.Methods:The medical records of 82 aged patients with Neer 3-part or 4-part proximal humeral fractures were analyzed retrospectively.Forty-four patients were treated with RSA(RSA group),while the others were treated with HA(HA group).The patients consisted of 51 males and 31 females,and ranged in age from 65 to 75 years(Median=70 yrs).The fractures located in left side for 45 patients and right side for 37 patients,and belonged to Neer 3-part(57)and 4-part(25)proximal humeral fractures.The operative time,intraoperative blood loss,fracture healing time and complications were compared between the 2 groups.The Neer shoulder scores obtained before the surgery and at 12 months after the surgery and the EuroQol-5 dimensions(EQ-5D)scores obtained at 4,8 and 12 weeks after the surgery were also compared between the 2 groups.The comprehensive curative effects were evaluated according to the Neer shoulder scores obtained at 12 months after the surgery.Results:The operative times were longer in RSA group compared to HA group(121.41+/-12.43 vs 101.32+/-17.51 min,t=6.050,P=0.001),and the intraoperative blood loss were more in RSA group compared to HA group(650.13+/-28.41 vs 581.41+/-30.20 mL,t=10.608,P=0.000).There was no statistical difference in fracture healing time between the 2 groups(15.42+/-2.10 vs 15.30+/-3.17 weeks,t=0.205,P=0.153).There was no statistical difference in Neer shoulder scores between the 2 groups before the surgery(50.41+/-5.22 vs 49.82+/-4.70 points,t=0.534,P=0.316).The Neer shoulder scores were higher in RSA group compared to HA group at 12 months after the surgery(80.40+/-4.11 vs 71.53+/-3.42 points,t=10.522,P=0.002).The Neer shoulder scores increased in both of the 2 groups at 12 months after the surgery(t=30.212,P=0.001; t=23.024,P=0.001).There was statistical difference in EQ-5D scores between different postoperative timepoints,in other words,there was time effect(F=18.760,P=0.001).There was statistical difference in EQ-5D scores between the 2 groups in general,in other words,there was group effect(F=2.811,P=0.036).The EQ-5D scores were higher in RSA group compared to HA group at 4 and 8 weeks after the surgery(0.52+/-0.07 vs 0.45+/-0.08 points,t=4.226,P=0.044; 0.61+/-0.07 vs 0.54+/-0.09 points,t=3.957,P=0.017).There was no statistical difference in EQ-5D scores between the 2 groups at 12 weeks after the surgery(0.68+/-0.08 vs 0.65+/-0.06 points,t=1.896,P=0.108).There was interaction between time factor and grouping factor(F=7.022,P=0.023).Twenty-two patients obtained an excellent result,15 good,5 fair and 2 poor in RSA group; while 13 patients obtained an excellent result,11 good,9 fair and 5 poor in HA group.The RSA group surpassed the HA group in the total curative effect(Z=-1.997,P=0.046).After the surgery,ankylosis(1 patient)and acromion impingement syndrome(1 patient)were found in RSA group,while ankylosis(4 patients)and acromion impingement syndrome(5 patients)were found in HA group.The postoperative complication rate was lower in RSA group compared to HA group(χ2=6.430,P=0.011).Conclusion:RSA has the disadvantages of longer operative time and more intraoperative blood loss compared to HA,and there is no significant difference in the fracture healing time between the two methods in the treatment of Neer 3-part and 4-part proximal humeral fractures in the aged,However,RSA can quickly improve patients' quality of life,and it surpasses HA in the comprehensive clinical curative effects and safety,so it is an ideal method for treatment of Neer 3-part and 4-part proximal humeral fractures in the aged,and it is worthy of popularizing in clinic.

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通讯作者:孙荣鑫 E-mail:735242874@qq.com
更新日期/Last Update: 2017-12-29