人工肱骨头假体置换与锁定板治疗复杂肱骨近端骨折的疗效对比

摘要

目的 比较人工肱骨头假体置换与锁定板治疗复杂肱骨近端骨折的疗效.方法 回顾性分析2013—2016年南通大学附属南京江北人民医院创伤关节外科收治的32例复杂肱骨近端骨折患者的临床资料,其中采取人工肱骨头假体置换治疗16例(置换组),采取锁定钢板内固定治疗16例(内固定组).比较两组患者一般手术情况、临床疗效、术后4周时VAS评分及Constant-Murley评分.结果 (1)两组患者在手术时间、术中出血量及一次性手术费用比较方面差异无统计学意义(P>0.05);(2)置换组Neer评分优良率为75.00%,内固定组Neer评分优良率为81.25%,两组比较差异无统计学意义(P>0.05);(3)置换组VAS评分(2.14 ±0.52)分,内固定组VAS评分(2.37 ±0.61)分,两组比较差异无统计学意义(P>0.05);(4)置换组Constant-Murley评分(65.28 ±13.04)分,内固定组Constant-Murley评分(61.44 ±11.62)分,两组比较差异无统计学意义(P>0.05).结论 人工肱骨头假体置换与锁定板治疗复杂肱骨近端骨折的手术时间、术中出血量及手术花费无明显差异,术后疗效相近.术式的选择主要依赖骨折复杂程度和患者一般状况.%Objective To compare the effect of artificial humeral head prosthesis replacement and locking plate in the treatment of complex proximal humeral fractures.Methods The clinical data of 32 patients with com-plex proximal humeral fractures admitted to Department of Orthopedics in Jiangbei People's Hospital from 2013 to 2016 were retrospectively analyzed.Among them,16 cases(replacement group)were treated with artificial humeral head prosthesis replacement,and 16 cases were treated with locking plate internal fixation(internal fixation group). The general operation condition,clinical efficacy,VAS score and Constant -Murley score at 4 weeks after operation were compared between the two groups.Results (1)There was no significant difference in operation time,amount of intraoperative bleeding and cost of one-off operation(P>0.05);(2)there was no significant difference in good rate of Neer score between the two groups(replacement group:75.00%;internal fixation group:81.25%)(P >0.05);(3)there was no significant difference in VAS between the two groups(replacement group:2.14 ±0.52;internal fixation group:2.37 ±0.61)(P>0.05);(4)there was no significant difference in Constant-Murley score between the two groups(replacement group:65.28 ±13.04;internal fixation group:61.44 ±11.62)(P>0.05). Conclusion There is no significant difference in operative time,intraoperative blood loss and operative cost be-tween artificial humeral head prosthesis replacement and locking plate in the treatment of complex proximal humeral fractures.The choice of the operation depends mainly on the indications ,complexity of the fracture and the general condition of the patients.