摘要
目的切开复位内固定、半肩关节置换及反式全肩关节置换术治疗肱骨近端复杂骨折的对比研究较少。文中旨在探讨3种术式治疗肱骨近端复杂骨折的临床疗效。方法回顾性分析2013年11月至2016年5月承德医学院附属医院关节外科收治的55例老年肱骨近端复杂骨折患者临床资料。依据不同术式,将55例老年患者分成3组:切开复位内固定组(n=20,切开复位锁定钢板内固定)、半肩关节置换组(n=20,人工肱骨头置换)及反式全肩关节置换组(n=15,头-盂倒置式肩关节置换)。术后定期复查,记录肩关节活动角度,采用美国肩与肘协会评分系统(ASES)评分,视觉模拟评分法(VAS)疼痛评分,加州大学肩关节评分系统(UCLA)评分及简明肩关节功能测试(SST)评分评价肩关节功能。结果术后6个月,半肩关节置换组内旋功能[(49.1±3.3)°]优于反式全肩关节置换组[(43.7±4.5)°]和切开复位内固定组[(41.7±5.0)°],但外旋功能[(25.7±5.4)°]差于反式全肩关节置换组和切开复位内固定组[(38.0±5.6)°、(39.5±4.6)°],差异有统计学意义(P<0.05)。反式全肩关节置换组前屈、外展功能优于半肩关节置换组和切开复位内固定组(P<0.05)。术后1年,3组ASES评分,VAS疼痛评分,UCLA评分及SST评分差异无统计学意义(P>0.05),并发症发生率差异亦无统计学意义(P>0.05)。结论3种术式均可治疗老年肱骨近端复杂骨折,疗效相当;反式全肩关节置换可更早的获得肩关节活动度,但缺乏中远期疗效,老年肱骨近端复杂骨折选取何种术式仍需临床医师结合手术适应证、个体化等因素综合考虑。
Objective There are few comparative researches on open reduction internal fixation,hemishoulder arthroplasty and reverse total shoulder arthroplasty for the treatment of complex proximal humeral fractures. The purpose of this study was to explore the clinical efficacy of three surgical methods for the treatment of complex proximal humeral fractures. Methods A retrospective study of 55 cases of complex proximal humeral fractures treated in our department from November 2013 to May 2016. According to different surgical methods,the patients were divided into three groups： open reduction internal fixation group of 20 cases（open reduction and internal fixation using locking plate）,hemishoulder arthroplasty group of 20 cases（artificial humeral head replacement）,reverse total shoulder arthroplasty group of 15 cases（head-glenoid inverted shoulder replacement）. Regular postoperative review was done to record the ranges of motion. The function of shoulder joint was evaluated by ASES score,VAS pain score,UCLA score and SST score.Results 6 months after the operation,the internal rotation function of the hemishoulder arthroplasty group[（49.1±3.3） °]was better than those of reverse total shoulder arthroplasty group [（43.7±4.5） °] and open reduction internal fixation group [（41.7±5.0） °],but the external rotation function[（25.7±5.4） °] was worse than the other two groups[（38.0±5.6） °,（39.5±4.6） °],the differences representing statistical significance（P〈0.05）. The functions of forward bending and external rotation of reverse total shoulder arthroplasty group were superior to hemishoulder arthroplasty group and open reduction and internal fixation group（P〈0.05）. 1 years after the operation,there was no significant difference among three groups in the aspects of ASES scores,VAS pain score,UCLA score,SST score and complication rate（P〉0.05）. Conclusion Three surgical methods can all be used in the treatment of complex proximal humeral fractures with equivalent effica
作者
戴海峰
刘凤
李嘉
王智慧
徐丛
吕永明
DAI Hai-feng;LIU Feng;LI Jia;WANG Zhi-hui;XU Cong;LU Yong-ming(Department of Joint Surgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei,China;Department of Emergency,Chengde Central Hospital,Chengde 067000,Hebei,China)
出处
《医学研究生学报》
CAS
北大核心
2018年第7期734-738,共5页
Journal of Medical Postgraduates
关键词
老年
肱骨近端骨折
切开复位内固定
半肩关节置换
反式全肩关节置换
疗效
elderly patients
proximal humeral fractures
open reduction and internal fixation
hemishoulder arthroplasty
reverse total shoulder replacement
curative effect
