人工半肩关节置换和钢板置入修复老年复杂肱骨近端骨折：肩关节功能比较

摘要

BACKGROUND:The repair method of proximal humeral comminuted fractures in the elderly remains controversial. OBJECTIVE:To compare the recovery of shoulder joint function using the hemiarthroplasty of shoulder and locking proximal humeral plate fixation for complex proximal humeral fracture in the elderly. METHODS:A total of 22 elderly patients with complex proximal humeral fracture, who were treated from October 2012 to October 2014, were retrospectively analyzed. 12 cases underwent hemiarthroplasty, and 10 cases received locking proximal humeral plate fixation. Al patients were folowed up after treatment. X-ray films were rechecked during the folow-up. The recovery of shoulder function was evaluated with Neer score. RESULTS AND CONCLUSION:During final folow-up, no prosthetic loosening or avascular necrosis of humeral head was found in the shoulder hemiarthroplasty group, and the Neer score was (81±5) points. In the locking proximal humeral plate fixation group, there was fixator loosening in four cases and avascular necrosis of humeral head in three cases, and the Neer score was (69±5) points (P < 0.05). During repair, mean operation time was shorter in the shoulder hemiarthroplasty group than in the locking proximal humeral plate fixation group. The amount of bleeding was higher in the shoulder hemiarthroplasty group than in the locking proximal humeral plate fixation group (P > 0.05). These data suggest that locking proximal humeral plate fixation and shoulder hemiarthroplasty are effective repair methods for complex proximal humerus fractures, but the hemiarthroplasty had the advantage of early functional exercise and good recovery of shoulder joint.%背景：老年肱骨近端粉碎性骨折的修复方法临床尚存在争议。目的：对比人工半肩关节置换与肱骨近端锁定钢板置入内固定修复老年肱骨近端复杂骨折的肩关节功能恢复情况。方法：回顾性分析2012年10月至2014年10月收治的老年肱骨近端复杂骨折患者22例，12例行人工半肩关节置换，10例行肱骨近端锁定钢板置入内固定。所有患者均进行治疗后随访，随访期内复查X射线片，并通过Neer评分评估肩关节功能恢复情况。结果与结论：末次随访，人工半肩关节置换组未见假体松动及肱骨头缺血坏死，Neer评分(81±5)分；肱骨近端锁定钢板内固定组内固定松动4例，肱骨头缺血坏死3例， Neer评分(69±5)分，组间差异有显著性意义(P <0.05)。在修复过程中，人工半肩关节置换组的平均手术时间低于肱骨近端锁定钢板内固定组，出血量前者高于后者，但组间差异无显著性意义(P >0.05)。提示肱骨近端锁定钢板置入内固定与人工半肩关节置换均为肱骨近端复杂骨折有效的修复手段，但人工半肩关节置换可更早的进行功能锻炼，肩关节恢复也较好。