目的 探讨两种不同的手术方法治疗骨质疏松患者肱骨近端复杂骨折的临床疗效.方法 2006年10月～2008年1月间,收治骨质疏松性复杂肱骨近端骨折47例,其中34例行切开复位钢板内固定术,13例行人工肱骨头置换术,记录两组术中、术后的多项相关指标及术后3～6个月的关节功能并予以统计学分析.结果 47例均获得随访,平均随访14.5个月;内固定组与人工肱骨头置换组相比,手术时间、切口长度、术中失血量、总输血量、术后引流量的差异均具有明显的统计学意义(P＜0.05);术后两组均未发生明显并发症;术后3～6个月疗效优良率内固定组为62.5%和82.4% 、人工肱骨头置换组为76.1%和84.6%;两组疗效优良率差别无明显统计学意义(P＞0.05).结论 两种治疗方法都适用于骨质疏松患者肱骨近端三、四部分骨折,但人工肱骨头置换手术创伤较小.%Objective To investigate the clinical effects of two different operative methods for the treatment of complex proximal humeral fractures of osteoporotic patients. Methods Totally 47 Osteoporotic patients with complex proximal humeral fractures were treated in our hospital during Oct. 2006 to Jan. 2008 ,including 30 cases of type Neer Ⅲ and 17 cases of type Neer Ⅳ. Thirty-four patients were treated by open reduction and internal fixation ( ORIF group) ,and the other 13 patients were treated by shoulder hemiarthroplasty( HAP group) . The relative indexes of intraoperative/postoperative situation and clinical effect ( ASES score) at 3-6 months postoperatively were observed and analyzed statistically. Results All cases were followed up, averaging 14. 5 months. The incision length , operation time , intraoperative blood loss , total volume of blood transfusion , postoperative drainage of the HAP group showed statistical difference comparing with the ORIF group. Both groups obtained satisfactory outcomes, and the rate of excellent and good at 3-6 months postoperatively was 82. 4％, 84. 6％ respectively in the HAP group,while 76. 1％ ,84. 6％ respectively in the ORIF group. The short - term follow-up indicated no differences between the two groups ( P＞0. 05 ) . Conclusion Both methods might constitute a reasonable and appropriate therapeutic option for the treatment of complex proximal humeral fractures( Neer Ⅲand Neer Ⅳ type ) of osteoporotic patient.But shoulder hemiarthroplasty may undergo less invasion; early mobilization and proper functional exercise can improve outcome and must be considered as essential elements of therapeutic procedure.
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