新型骨水泥强化螺钉结合锁定钢板内固定与人工肱骨头置换治疗肱骨近端骨质疏松性骨折的比较

文题释义： 骨水泥强化螺钉技术：骨质疏松是中老年常见的代谢性疾病，常导致内固定松动而致内固定失败。而骨水泥强化螺钉技术是预防螺钉松动的有效办法，主要用于骨质疏松性骨折。肱骨近端骨水泥强化螺钉技术是通过空心螺钉通道将骨水泥注入肱骨头松质骨中，使螺钉及骨质有良好的整合作用、防止螺钉松动，同时对疏松的骨质起到支撑作用，防止肱骨头塌陷。 肱骨近端骨折：是指大结节基底部以上部位的骨折，包括外科颈；Neer 和Codman 将肱骨近端分成4个基本解剖结构：大结节、小结节、肱骨干、肱骨头，大小结节间的结节间沟是肱骨近端骨折复位的标志性结构。约87%的患者骨折发生于低能量损伤，可能和骨质疏松相关。肱骨近端骨折是目前第三常见的骨质疏松性骨折，同时肱骨近端骨质疏松性骨折是临床治疗的一个难点。 背景：为解决骨质疏松骨折行内固定可能出现的螺钉切出、松动、把持力不足等并发症，目前一种新的骨水泥强化螺钉技术结合PHILOS锁定钢板被用于治疗肱骨近端骨质疏松性骨折，但国内应用该技术治疗肱骨近端骨质疏松性骨折的临床疗效鲜见报道。 目的：比较新型骨水泥强化螺钉技术结合锁定钢板内固定与人工肱骨头置换治疗肱骨近端骨质疏松性骨折的临床疗效。 方法：选择2017年2月至2019年3月贵州省人民医院收治的肱骨近端骨质疏松性骨折患者22例，其中男8例，女14例，年龄68-88岁，其中10例行骨折切开复位新型骨水泥强化螺钉技术结合锁定钢板内固定治疗(内固定组)，另12例行人工肱骨头置换治疗(肱骨头置换组)。比较两组手术时间、术中出血量、术中及术后并发症；术后6个月进行肩关节目测类比评分及肩关节Constant评分等。术后所有患者均给予抗骨质疏松治疗。试验获得贵州省人民医院伦理委员会批准，批准号：2017(02)号。 结果与结论：①22例患者均获得随访，随访时间6-15个月，平均(9.0±1.6)个月；②两组术中未出现骨水泥毒性反应、栓塞等并发症；内固定组术后1例出现肩关节僵硬，两组术后未出现切口感染、异位性骨化、骨折延迟愈合及不愈合，未出现螺钉拔出及切割等不良反应；③内固定组手术时间及术中出血量少于肱骨头置换组(P < 0.05)；④两组术后6个月的目测类比评分与肩关节Constant评分优良率比较差异均无显著性意义(P > 0.05)；⑤结果表明，新型骨水泥强化螺钉技术结合锁定钢板内固定治疗肱骨近端骨质疏松性骨折可获得与人工肱骨头置换相近的临床疗效，是部分可能需行肩关节置换患者选择内固定治疗的一种治疗方法补充。 ORCID: 0000-0002-8139-1175(佘荣峰) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

A novel cement-reinforced screw combined with locking plate fixation versus humeral head arthroplasty in the treatment of osteoporotic fractures of the proximal humerus

BACKGROUND:To solve the complications such as screw cut-out,loosening,and insufficient holding force that may occur during internal fixation of osteoporotic fractures,a new cement-reinforced screw combined with PHILOS plate is currently used to treat osteoporotic fracture of the proximal humerus.However,there are few reports on the clinical efficacy of this technique in the treatment of osteoporotic fractures of the proximal humerus in China.OBJECTIVE:To compare the clinical efficacy of a novel cement-reinforced screw combined with locking plate fixation and artificial humeral head replacement in the treatment of osteoporotic fractures of the proximal humerus.METHODS:Twenty-two patients with osteoporotic fractures of the proximal humerus admitted to at Guizhou Provincial People’s Hospital from February 2017 to March 2019 were enrolled,including 8 males and 14 females,aged 68-88 years.Ten patients underwent open reduction using new cement-reinforced screws combined with locking plate internal fixation(internal fixation group),and 12 patients underwent humeral head arthroplasty(humeral head arthroplasty group).The operation time,intraoperative blood loss,and intraoperative and postoperative complications were compared.The Visual Analogue Scale and Constant scores of the shoulder joint were detected at 6 months after surgery.All patients received a postoperative anti-osteoporosis treatment.The study was approved by the Ethics Committee of Guizhou Provincial People’s Hospital,approval No.2017(02).RESULTS AND CONCLUSION:(1)Twenty-two patients were followed up for 6-15 months,an average of(9.0±1.6)months.(2)No toxicity reaction of bone cement or embolism occurred in both groups.One case of postoperative shoulder stiffness occurred in the internal fixation group.There were no complications in both groups,such as incision infection,heterotopic ossification,delayed healing,and screw cut-out.(3)The operation time and intraoperative blood loss in the internal fixation group were significantly less than those in the humeral head arthroplasty group(P<0.05).(4)The Visual Analogue Scale and the excellent and good rate of Constant scores of the shoulder joint at 6 months after surgery showed no significant differences between two groups(P>0.05).(5)In summary,the novel cement-reinforced screw technique combined with locking plate internal fixation has similar clinical efficacy with humeral head arthroplasty.Therefore,this new technique is an alternative internal fixation method for some patients scheduled for shoulder joint arthroplasty.