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[1]柴浩,張磊,孫榮鑫.半關(guān)節(jié)成形術(shù)和反式肩關(guān)節(jié)置換術(shù)治療老年肱骨近端Neer三、四部分骨折的對比研究[J].中醫(yī)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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半關(guān)節(jié)成形術(shù)和反式肩關(guān)節(jié)置換術(shù)治療老年肱骨近端Neer三、四部分骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年07期
頁碼:
21-26
欄目:
臨床研究
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; 張磊2; 孫榮鑫1
1.新疆醫(yī)科大學第六附屬醫(yī)院,新疆 烏魯木齊 830002; 2.中國人民武裝警察部隊新疆生產(chǎn)建設(shè)兵團指揮部醫(yī)院,新疆 烏魯木齊 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
關(guān)鍵詞:
肩骨折;  肱骨骨折;  反式肩關(guān)節(jié)置換術(shù);  半關(guān)節(jié)成形術(shù);  老年人
Keywords:
Key words shoulder fractures;  humeral fractures;  reverse shoulder arthroplasty;  hemiarthroplasty;  aged
摘要:
目的:比較半關(guān)節(jié)成形術(shù)(hemiarthroplasty,HA)和反式肩關(guān)節(jié)置換術(shù)(reverse shoulder arthroplasty,RSA)治療老年肱骨近端Neer三、四部分骨折的臨床療效和安全性。方法:回顧性分析82例老年肱骨近端Neer三、四部分骨折患者的病例資料,其中采用RSA治療44例,采用HA治療38例; 男51例,女31例; 年齡65～75歲,中位數(shù)70歲; 左側(cè)45例,右側(cè)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。比較2組患者的手術(shù)時間、術(shù)中出血量、骨折愈合時間和并發(fā)癥發(fā)生情況,比較2組患者的術(shù)前、術(shù)后12個月肩關(guān)節(jié)Neer評分以及術(shù)后4周、8周、12周歐洲五維健康量表(EuroQol-5 dimensions,EQ-5D)評分,并根據(jù)術(shù)后12個月的肩關(guān)節(jié)Neer評分評價綜合療效。結(jié)果:①一般指標。RSA組手術(shù)時間長于HA組[(121.41±12.43)min,(101.32±17.51)min,t=6.050,P=0.001)],術(shù)中出血量多于HA組[(650.13±28.41)mL,(581.41±30.20)mL,t=10.608,P=0.000]; 2組患者骨折愈合時間比較,差異無統(tǒng)計學意義[(15.42±2.10)周,(15.30±3.17)周,t=0.205,P=0.153]。②肩關(guān)節(jié)Neer評分。2組患者術(shù)前肩關(guān)節(jié)Neer評分比較,差異無統(tǒng)計學意義[(50.41±5.22)分,(49.82±4.70)分,t=0.534,P=0.316]; 術(shù)后12個月,RSA組肩關(guān)節(jié)Neer評分高于HA組[(80.40±4.11)分,(71.53±3.42)分,t=10.522,P=0.002],2組患者肩關(guān)節(jié)Neer評分均較術(shù)前升高(t=30.212,P=0.001; t=23.024,P=0.001)。③EQ-5D評分。術(shù)后不同時間點間EQ-5D評分的差異有統(tǒng)計學意義,即存在時間效應(F=18.760,P=0.001); 2組患者EQ-5D評分總體比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=2.811,P=0.036); 術(shù)后4周、術(shù)后8周,RSA組EQ-5D評分高于HA組[(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]; 術(shù)后12周2組患者EQ-5D評分比較,組間差異無統(tǒng)計學意義[(0.68±0.08)分,(0.65±0.06)分,t=1.896,P=0.108]; 時間因素與分組因素存在交互效應(F=7.022,P=0.023)。④綜合療效。RSA組優(yōu)22例、良15例、可5例、差2例,HA組優(yōu)13例、良11例、可9例、差5例; RSA組綜合療效優(yōu)于HA組(Z=-1.997,P=0.046)。⑤安全性。RSA組術(shù)后發(fā)生關(guān)節(jié)僵硬1例、肩峰撞擊征1例,HA組術(shù)后發(fā)生關(guān)節(jié)僵硬4例、肩峰撞擊征5例,RSA組并發(fā)癥發(fā)生率低于HA組(χ2=6.430,P=0.011)。結(jié)論:對于老年肱骨近端Neer三、四部分骨折患者而言,雖然RSA術(shù)比HA術(shù)的手術(shù)時間長、術(shù)中出血量多,且二者在骨折愈合時間方面無明顯差異; 但與HA術(shù)相比,采用RSA術(shù)能快速改善患者生活質(zhì)量,且綜合療效和安全性均優(yōu)于HA術(shù),是治療老年肱骨近端Neer三、四部分骨折的一種較理想的方法,值得臨床推廣應用。
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.

參考文獻/References:

[1] 賈柯,徐克武,胡翔.老年肱骨近端骨折分型及臨床治療進展[J].中醫(yī)正骨,2017,29(3):24-27.
[2] DEIN EJ,HURI G,GORDON JC,et al.A humerus fracture in a baseball pitcher after biceps tenodesis[J].Am J Sports Med,2014,42(4):877-879.
[3] 張敏,白鵬程,張媺,等.PHILOS鎖定鋼板與人工肱骨頭置換治療老年復雜肱骨近端骨折的效果對比[J].安徽醫(yī)學,2015,40(4):441-444.
[4] 饒海群,黃大江,吳淵,等.肱骨近端骨折保守治療后并發(fā)癥的探討[J].中國矯形外科雜志,2014,22(22):2049-2052.
[5] 孫鵬,譚磊,閻乾,等.人工肱骨頭置換術(shù)治療老年肱骨近端 Neer 三、四部分骨折[J].中醫(yī)正骨,2016,28(5):43-45.
[6] 賈小林,周明全,胡維,等.反式全肩關(guān)節(jié)置換術(shù)治療高齡肱骨近端骨折骨不連[J].中華關(guān)節(jié)外科雜志:電子版,2015,9(5):575-578.
[7] Neer CS 2nd.Displaced proximal humeral fractures.Ⅰ.Classification and evalution.J Bone Joint Surg(Am),1970,52(6):1077-1089.
[8] 李明暉,羅南.歐洲五維健康量表(EQ-5D)中文版應用介紹[J].中國藥物經(jīng)濟學,2009,4(1):49-57.
[9] 陳康樂,鄭康偉,陳凱.人工肱骨頭置換術(shù)治療肱骨近端Neer四部分骨折[J].中醫(yī)正骨,2014,26(6):57-59.
[10] TAN E,LIE D,WONG MK.Early outcomes of proximal humerus fracture fixation with locking plate and intramedullary fibular strut graft[J].Orthopedics,2014,37(9):e822-e827.
[11] 梁發(fā)樹,廖詩偉,李健民,等.鎖定鋼板治療老年性肱骨近端骨折的臨床觀察[J].中國中醫(yī)骨傷科雜志,2014,22(3):61-62.
[12] 蔣繼樂,蔣協(xié)遠.老年肱骨遠端骨折的治療:切開復位內(nèi)固定還是全肘關(guān)節(jié)置換術(shù)[J].中華創(chuàng)傷骨科雜志,2015,17(4):357-361.
[13] 孫祥水,樓躍,范毓華,等.三種內(nèi)固定方法治療大齡兒童肱骨近端骨折的臨床分析[J].中華小兒外科雜志,2014,35(1):6-10.
[14] 趙東升,余清文,鄭曉勇,等.后方MIPO技術(shù)治療肱骨干中下段骨折的初步臨床報告[J].中國矯形外科雜志,2015,23(22):2099-2102.
[15] 賈小林,周明全,胡維,等.反式全肩關(guān)節(jié)置換治療高齡肱骨近端粉碎性骨折[J].中國矯形外科雜志,2015,23(12):1136-1138.
[16] 居紅飛.全肩關(guān)節(jié)置換術(shù)患者術(shù)后肩關(guān)節(jié)功能和生存質(zhì)量的改善[J].江蘇醫(yī)藥,2016,42(2):166-168.
[17] 邢方凱,丁紅濤.反式與半肩關(guān)節(jié)置換術(shù)治療老年肱骨骨折的療效對比[J].中華關(guān)節(jié)外科雜志:電子版,2016,10(2):59-64.
[18] 王東,劉洋,周君琳.反置式人工全肩關(guān)節(jié)置換術(shù)治療肱骨近端骨折的研究進展[J].中華肩肘外科電子雜志,2015,3(2):1-6.

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備注/Memo

備注/Memo:
通訊作者:孫榮鑫 E-mail:[email protected]
更新日期/Last Update: 2017-12-29