肱骨近端锁定板和人工肱骨头置换治疗肱骨近端三、四部分骨折的疗效分析

目的探讨切开复位肱骨近端锁定接骨板(locking proximal humeral plate,LPHP)内固定与人工肱骨头置换治疗老年肱骨近端三、四部分骨折的临床疗效。方法回顾性分析2010年4月至2013年3月我科治疗96例肱骨近端三、四部分骨折患者,根据不同术式分为两组:LPHP组,55例,行切开复位肱骨近端锁定接骨板内固定手术;置换组,41例,行人工肱骨头置换。所有病例于术后第1、3、6、12、18个月进行门诊复查及随访,比较两组患者的手术时间、出血量、术后并发症发生率以及末次随访时的肩关节Neer评分和疼痛视觉模拟量表(visual analogue scale,VAS)评分。结果两组患者的手术时间、术中出血量、术后并发症发生率以及末次随访时肩关节功能Neer评分和VAS评分等中短期疗效之间,差异均无统计学意义(均P>0.05)。结论切开复位LPHP内固定与人工肱骨头置换治疗肱骨近端三、四部分骨折,均可达到较满意的临床疗效,两种手术方式的选择更多依赖于适应证,人工肱骨头置换因术中涉及对肱骨头进行不可逆的切除,选择需相当慎重。两种术式的远期临床疗效,仍需进行长期的随访观察。

The effectiveness of open reduction locked proximal humeral plate treatment vs. artificial humerus head replacement for three, four parts fracture of proximal humerus

Objective To discuss the effectiveness of two kinds of operation methods of open reduction locked proximal humeral plate treatment vs. artificial humerus head replacement for three, four parts fracture of proximal humerus. Methods A total of 96 patients with three, four parts fracture of proximal humerus treated by two kinds of surgical treatments were retrospectively analyzed and followe up in our department between Apr. 2010 and Mar. 2013. They were categorized into 2 groups according to the different surgical procedures in all cases: 55 patients were given incision locked proximal humeral plate treatment, and 41 patients given artificial humerus head replacement. All patients were reviewed and followed up after surgical operations in the clinic at 1st, 3rd, 6th, 12th and 18th month respectively. The operative time, amount of bleeding, Neer scores of the shoulder function, visual analog scale (VAS) pain scores, and the incidence of postoperative complications were compared between two groups. Results There were no significant differences between two groups in the operative time, the amount of bleeding, the incidence of postoperative complications, VAS scores and Neer scores (all P>0.05). Conclusion Two kinds of operation methods can achieve satisfactory clinical efficacy for three, four parts fracture of proximal humerus, but the choice of those two kinds of operation methods are more dependent on correct indications, because the artificial humerus head replacement needs resection of humerus head in the operation irreversibly, so the choice of surgical patients should be quite careful. The long-term clinical curative effectiveness of those operation methods still needs long-term follow-up investigation.