摘要
[目的]比较分析锁定钢板和人工肱骨头置换治疗肱骨近端粉碎性骨折的中短期疗效。[方法]回顾性分析本院骨科2009年1月～2011年6月采用肱骨近端锁定钢板和人工肱骨头置换治疗Neer 3、4部分肱骨近端骨折患者61例,按随机数字表法分为2组,分别为应用锁定钢板内固定治疗组(内固定组,n=35)和人工肱骨头置换治疗组(置换组,n=26)。其中内固定组含Neer 3部分骨折23例,4部分骨折12例;置换组含Neer 3部分骨折5例,4部分骨折21例。比较分析两组手术时间、术中出血量及一次性住院费用,同时采用Neer评分标准从关节疼痛、活动、功能等方面评定两组临床疗效。[结果]两组随访时间相仿,平均随访时间为20.5个月(12～36个月)。内固定组手术时间平均为(60±5)min,术中出血量平均为(300±10)ml,一次性住院费用平均为(37 940±3 500)元,Neer评分优良率为86.2%;置换组手术时间平均为(50±5)min,术中出血量平均为(350±20)ml,一次性住院费用平均为(38 850±4 800)元,Neer评分优良率为90.0%。两组手术时间、术中出血量、一次性住院费用以及术后随访Neer评分比较差异均无统计学意义(P>0.05)。[结论]锁定钢板与人工肱骨头置换治疗肱骨近端粉碎骨折的手术时间、出血量及住院费用相仿,术后均能达到满意的临床疗效。2种手术方式的选择取决于筛选正确的适应证,对于年龄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,人工肱骨头置换则是最佳选择。
[ Objective ] To comparate and analyse the short - term clinical efficacy of locking plates and humeral head pros- thesis for proximal humeral complicated fractures. [ Method] The retrospective data of 61 cases deal with locking plate or humeral head prosthesis replacement for treatment of comminuted proximal humeral fractures were collected from January 2009 to June 2011 in our hospital. According to Neer classification, they were part three and part four fractures. Deal with locking plate （ n = 35 ）, part three fractures of proximal humeral were （ n = 23 ） and part four （ n = 12 ）, Deal with humeral head prosthesis re- placement（ n = 26） ,part three fractures ofproximal humeral were（ n = 5） and part four（ n = 21 ）. The operative time,blood loss and a one - time cost of hospitalization were contrasted between two groups, and the curative effect was also evaluated according to Neer scoring system. [ Result] In the internal fixation group： the mean operative time was 60 ± 5 min,the mean intraopera- tive blood loss was 300 ±10ml, and the disposable hospital average cost was S 37 940 ± 3 500. In the replacement group： the mean operative time was 50 ± 5 min,the mean intraoperative blood loss was 350 ± 20ml, and the disposable hospital average cost was S 38 850 ±4 800. The follow up was ranging from 12 to 36 months（mean,20.5months）. Assessed by Neer scoring system,The rate of excellent and good results was 86.2% in locking plate group,no significance was found to humeral head prosthesis group 90% （P 〉 0. 05）. [ Conclusion ] Locking plate and humeral head prosthesis in the treatment of proximal humerus comminuted fracture were similar in the operative time, intraoperative blood, disposable hospital average cost, and both of them were able to achieve a satisfactory clinical outcome. Two choies of surgical approach depend on the screening of the correct indications. The locking plate fixation is the best option to the person who is young and is able to reach intraoperative reposition-ing. The humeral head prosthesis is the best choice to the old person with severely comminuted proximal humerus fractures.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第10期963-968,共6页
Orthopedic Journal of China
基金
广东省科技计划项目(编号:粤科函社字[2010]1096)
关键词
肱骨近端
粉碎性骨折
锁定钢板
人工肱骨头置换
proximal humeral, comminuted fractures, locking plate fixation, humeral head replacement
