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[1]何幫劍,金紅婷,呂一,等.切開復(fù)位鎖定鋼板內(nèi)固定和人工肱骨頭置換治療高齡肱骨近端粉碎性骨折的對比研究[J].中醫(yī)正骨,2013,25(01):26-29.
　HE Bang-jian*,JIN Hong-ting,LV Yi,et al.A retrospective trial of open reduction and locking plate internal fixation versus hemiarthroplasty for comminuted proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(01):26-29.
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切開復(fù)位鎖定鋼板內(nèi)固定和人工肱骨頭置換治療高齡肱骨 近端粉碎性骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期數(shù):
2013年01期
頁碼:
26-29
欄目:
關(guān)節(jié)置換
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:
何幫劍1; 金紅婷2; 呂一1; 季四青1; 周國慶1; 童培建3
1.浙江中醫(yī)藥大學(xué)附屬第三醫(yī)院,浙江 杭州 310005;
2.浙江中醫(yī)藥大學(xué), 浙江 杭州 310053;
3.浙江中醫(yī)藥大學(xué)附屬第一醫(yī)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
關(guān)鍵詞:
肩骨折 肱骨骨折 骨折固定術(shù); 內(nèi) 骨板 關(guān)節(jié)成形術(shù); 置換 治療; 臨床研究性
Keywords:
Shoulder fractures;  Humeral fractures;  Fracture fixation; internal;  Bone plates;  Arthroplasty; replacement;  Therapies; investigational
摘要:
目的:比較切開復(fù)位鎖定鋼板內(nèi)固定和人工肱骨頭置換治療高齡肱骨近端骨折的臨床療效和安全性。方法:回顧性分析接受手術(shù)治療的50例高齡肱骨近端粉碎性骨折患者的病歷資料,采用切開復(fù)位鎖定鋼板內(nèi)固定治療者23例(A組),采用人工肱骨頭置換治療者27例(B組)。比較2組患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量及住院時(shí)間,比較2組患者末次隨訪時(shí)的Constant-Murley肩關(guān)節(jié)評分,同時(shí)比較患者術(shù)后及隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:①一般情況。B組患者的手術(shù)時(shí)間[(70.74±10.16)min]、術(shù)中出血量[(192.96±50.29)mL]、術(shù)后引流量[(52.78±10.59)mL]及住院時(shí)間[(9.78±2.14)d]均少于A組[(92.17±11.66)min,(242.61±63.48)mL,(74.35±20.91)mL,(14.22±4.30)d],差異均有統(tǒng)計(jì)學(xué)意義(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評分。2組患者的肩關(guān)節(jié)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]、肩關(guān)節(jié)活動(dòng)度[(28.70±7.71)分,(30.59±7.72)分]、上肢肌力評分[(13.48±3.37)分,(13.30±3.18)分]及Constant-Murley總分[(70.57±9.31)分,(73.00±7.61)分]比較,差異均無統(tǒng)計(jì)學(xué)意義(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組患者均獲隨訪,隨訪時(shí)間24～72個(gè)月,中位數(shù)51.5個(gè)月。A組1例患者出現(xiàn)肩關(guān)節(jié)僵硬,1例發(fā)生肱骨頭無菌性壞死,未發(fā)生內(nèi)固定斷裂或松動(dòng)等并發(fā)癥; B組1例患者出現(xiàn)關(guān)節(jié)不穩(wěn),未發(fā)生假體松動(dòng)、假體周圍骨折及血管神經(jīng)損傷等并發(fā)癥。2組患者并發(fā)癥發(fā)生情況比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.021,P=0.886)。結(jié)論:切開復(fù)位鎖定鋼板內(nèi)固定和人工肱骨頭置換治療高齡肱骨近端粉碎性骨折的療效和安全性相當(dāng),但后者具有手術(shù)時(shí)間短、出血量少、術(shù)后引流量少及住院時(shí)間短的優(yōu)勢。因此,對于高齡肱骨近端粉碎性骨折,尤其是合并重度骨質(zhì)疏松者,建議采用人工肱骨頭置換術(shù)治療。
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.

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備注/Memo

備注/Memo:
通訊作者:童培建 E-mail:[email protected]
更新日期/Last Update: 2013-01-20