两种手术治疗四部分肱骨近端骨折的对比研究

目的探讨与分析切开复位钢板内固定和人工肱骨头置换两种不同手术方案治疗四部分肱骨近端骨折的适应证和早期疗效。方法对48例四部分肱骨近端骨折进行切开复位钢板内固定和人工肱骨头置换术,术后6周、3个月及半年时进行随访,关节功能应用美国肩肘外科医师协会评分（rating scale of the American shoulder and elbowsurgeons,ASES）、Constant-Murley评分及美国加州大学肩关节成形改良评分（scoring system modification for hemi-arthroplasty of UCLA,UCLA-SSMH）,并对关节活动度及满意度进行评定。结果术后6周时人工关节置换组肩关节功能明显优于切开复位钢板内固定组,3个月及半年时两组肩关节功能无统计学差异。所有48例患者术后半年时ASES评分平均（72.26±10.18）分,Constant-Murley评分平均（72.15±11.63）分,UCLA-SSMH评分平均（23.54±3.89）分,视觉模拟疼痛评分平均（1.52±1.11）分,肩关节前屈上举（124.90±27.14）°,外举（89.62±23.05）°,外旋（21.56±4.51）°,内旋达L2～L3,对疼痛满意度为95.8%,日常功能活动满意度为87.5%。结论对于四部分肱骨近端骨折,切开复位钢板内固定和人工肱骨头置换术均可取得较满意的结果。人工肱骨头置换组可较早获得满意的肩关节功能。

Comparative Research of the Outcomes after Two Different Methods for Treatment of Four-Part Proximal Humerus Fractures

Objective To investigate indications and early results in the treatment of four-part proximal humerus fractures with open reduction and internal fixation(ORIF) with plate and humeral head replacement.Methods Forty-eight patients who received ORIF with plate and humeral head replacement were followed up.ASES score,Constant-Murley score,UCLA-SSMH score,range of motion and satisfaction rate had been adopted for evaluating the shoulder function at the time of 6 weeks,3 months and half a year after the operation.Results The shoulder function of humeral head replacement group was superior to ORIF group at 6 weeks after operation.At 3 months or half a year after the operation,the shoulder function had no statistically significant difference between the two groups.The mean ASES score was(72.26±10.18),Constant-Murley score was(72.15±11.63),UCLA-SSMH score was(23.54±3.89),VAS score was(1.52±1.11);The mean forward flexion was(124.90±27.14)°,abduction was(89.62±23.05)°,external rotation was(21.56±4.51)°,internal rotation was up to L2~L3 level at half a year after the operation.The total satisfaction rate for pain relief was 95.8%,and functional recovery was 87.5%.Conclusion For the treatment of four-part proximal humerus fractures,satisfactory results could both be obtained in ORIF with plate and humeral head replacement.Patients who received humeral head replacement could make an earlier recovery.