肱骨近端粉碎骨折锁定钢板与人工肱骨头置换术的对比研究

目的探讨应用肱骨近端锁定钢板和人工肱骨头置换治疗肱骨近端复杂骨折的近期疗效。方法回顾性分析我科自2006年1月至2009年12月期间采用肱骨近端锁定钢板和人工肱骨头置换治疗Neer三、四部分肱骨近端骨折患者37例，行肱骨近端锁定钢板治疗肱骨近端骨折20例，其中Neer三部分骨折14例，四部分骨折6例；人工肱骨头置换治疗肱骨近端骨折17例，均为四部分骨折。采用Neer评分标准从疼痛、活动、功能等方面评定两组疗效。结果平均随访时间为20个月（12～30个月）。内固定组优良率为83．3％，置换组优良率为87．5％，两组比较差异无统计学意义（P〉0．05）。结论锁定钢板与人工肱骨头置换在治疗肱骨近端粉碎骨折均能达到满意的疗效，但对于骨折严重粉碎无法重建的肱骨近端骨折，尤其伴有严重骨质疏松的老年患者，人工肱骨头置换仍是最佳选择。

Single Centre Retrospective Control Study on Locking Plate Versus Humeral Head Prosthesis Replacement for Treatment of Comminuted Proximal Humeral Fractures

Objective To evaluate the short term effect of locking plate and humeral head prosthesis for proximal humeral complicated fractures.Methods The retrospective data of 37 cases deal with Locking Plate or Humeral head prosthesis replacement for treatment of comminuted proximalhumeral fractures collected from January 2006 to December 2009 in our hospital,which according to Neer classification,part three and part four fractures.Deal with Locking Plate(n=20),part three fractures of proximal humeral were(n=14) and part four(n=6),Deal with Humeral head prosthesis replacement(n=17),all were part four.The curative effect was evaluated according to Neer scoring system.Results The average follow up was 20 months(ranging from 12 to 30 months).Assessed by Neer scoring system,The rate of excellent and good was 83.3% in locking plate group,no significance than that in humeral head prosthesis group 87.5%(P>0.05).Conclusion However Locking plate and humeral head prosthesis show good results for proximal humeral complicated fractures,in serious comminuted proximal humeral fractures which were difficultly reconstituted or osteoporotic patient,humeral head prosthesis replacement may be best selection.