| 老年3部分与4部分肱骨近端骨折人工肱骨头置换与内固定治疗的病例对照研究 |
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Received:December 30, 2009
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| 作者 | Author | 单位 | Unit | E-Mail |
| 章军辉 |
ZHANG Jun-hui |
宁波市第六医院关节外科,浙江 宁波 315040 |
Department of Joint Surgery,the No.6 Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
jhzhang933@sohu.com |
| 狄正林 |
DI Zheng-lin |
宁波市第六医院关节外科,浙江 宁波 315040 |
Department of Joint Surgery,the No.6 Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 何志勇 |
HE Zhi-yong |
宁波市第六医院关节外科,浙江 宁波 315040 |
Department of Joint Surgery,the No.6 Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 冯建翔 |
FENG Jian-Xiang |
宁波市第六医院关节外科,浙江 宁波 315040 |
Department of Joint Surgery,the No.6 Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 徐荣明 |
XU Rong-ming |
宁波市第六医院关节外科,浙江 宁波 315040 |
Department of Joint Surgery,the No.6 Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 期刊信息：《中国骨伤》2010年23卷，第6期，第435-439页 |
| DOI：10.3969/j.issn.1003-0034.2010.06.0013 |
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目的：比较老年3部分与4部分肱骨近端骨折行人工肱骨头置换与内固定治疗适应证、手术技巧以及早期随访疗效。
方法：自2004年7月至2006年7月，对58例肱骨近端骨折分2组治疗:AO锁定加压钢板(LCP)组与人工肱骨头置换组。LCP组28例，男12例，女16例；平均年龄(66.5± 1.4)岁；3部分骨折24例，3部分骨折伴脱位1例，4部分骨折2例，4部分骨折伴脱位1例。人工肱骨头置换组30例，男12例，女18例；平均年龄(68.9± 3.5)岁；3部分骨折9例，3部分骨折伴脱位2例，4部分骨折12例，4部分骨折伴脱位4例，肱骨头劈裂型骨折3例。分别在术后即刻及术后第2、6、10、16周和6个月，以及最终随访时拍摄X线片。最终随访时应用VAS疼痛评分、ASES(American shouder and elbow surgeon)评分、Constant-Murley 评分、UCLA 评分以及SST(simple shoulder test)问卷评估治疗结果。
结果：LCP组平均随访29.8个月，人工肱骨头置换组平均随访28.2个月。VAS疼痛评分:LCP组平均(2.2±1.5)分，人工肱骨头置换组平均(2.6±1.9)分，两组差异有统计学意义(P=0.002)。肩关节活动度前屈上举:LCP组110.2°(81°～130°)，人工肱骨头置换组120.2°(89°～140°)，差异有统计学意义(P=0.031)。ASES评分:LCP组平均(87.7±2.2)分，人工肱骨头置换组平均(86.4±4.5)分。Constant-Murley评分:LCP组平均(83.9±6.8)分，人工肱骨头置换组平均(85.5±5.6)分。UCLA 评分:LCP组平均(30.3±2.2)分，人工肱骨头置换组平均(31.2±2.1)分。SST 问卷中回答“是”的问题:LCP组平均(8.0±0.9)个，人工肱骨头置换组平均(9.0±0.7)个。两组ASES评分、Constant-Murley评分、UCLA评分以及SST问卷比较差异无统计学意义。
结论：对于老年3部分与4部分肱骨近端骨折行切复LCP内固定与人工肱骨头置换都是有效的治疗手段。人工肱骨头置换术技术要求高，手术适应证应严格选择，其良好疗效的获得依赖于假体尽可能地解剖安放以及肩袖止点的良好重建。 |
| [关键词]:肱骨骨折 肩 骨折固定术,内 人工关节 临床对照试验 |
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| Comparison of humeral head replacement and internal fixation for the treatment of 3 parts and 4 parts fractures of proximal humerus in the elderly |
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Abstract:
Objectives: To compare the indication,technical keys during surgery and early results of humeral head replacement and internal fixation for the 3 parts and 4 parts fractures of proximal humerus in the elderly.
Methods: From July. 2004 to July. 2006,58 patients with 3 parts and 4 parts fractures of proximal humerus were randomly treated with AO locked compressive plates(LCP)or humeral head replacement. In LCP group,there were 12 males and 16 females with an average age of(66.5±1.4)years,including 24 cases of 3 parts fractures,1 case of 3 parts fractures with dislocation,2 cases of 4 parts fractures and 1 case of 4 parts fractures with dislocation. In the humeral head replacement group,there were 12 males and 18 females with an average age of(68.9± 3.5) years,including 9 cases of 3 parts fractures,2 cases of 3 parts fractures with dislocation,12 cases of 4 parts fractures,4 cases of 4 parts fractures with dislocation and 3 cases of humeral head split fractures. Trauma series X-rays of shoulder were taken after operation,2-week,6-week,10-week,16-week,6-month and the latest followed-up. VAS,SST(simple shoulder test)questionnaire,ASES(American shoulder & elbow surgeon)score,Constant-Murley score and UCLA score had been adopted for evaluation at the latest followed-up.
Results: The mean followed-up period of LCP group was 29.8 months and that of humeral head replacement group was 28.2 months. VAS of LCP group and humeral head replacement group were(2.2±1.5)and (2.6±1.9),respectively. There was a statisticaly difference between the two groups(P=0.002). The degrees of forward elevation of shoulder in LCP group and humeral head replacement group were 110.2°(81° to 130°) and 120.2°(89° to 140°),respectively. There was a statistical difference between the two groups(P=0.031). ASES score,Constant-Murley score,UCLA score and response ＂yes＂ in SST questionnaire in LCP group were 87.7±2.2,83.9±6.8,30.3±2.2,8.0±0.9,and in humeral head replacement group were 86.4±4.5,85.5±5.6,31.2±2.1,9.0±0.7,respectively.There was no significant difference between the two groups in ASES score,Constant-Murley score,UCLA score and SST questionnaire.
Conclusion: Both humeral head replacement and internal fixation are effective treatment for the 3 parts and 4 parts fracture of proximal humerus in the elderly. Humeral head replacement is more technically demanding and has a strict indications. The satisfactory results of humeral head replacement are based on the suitable placement of prostheses and the correct reconstruction of rotator cuff insertion. |
| KEYWORDS:Humeral fractures Shoulder Fracture fixation,internal Joint prosthesis Controlled clinical trials |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 章军辉,狄正林,何志勇,冯建翔,徐荣明.老年3部分与4部分肱骨近端骨折人工肱骨头置换与内固定治疗的病例对照研究[J].中国骨伤,2010,23(6):435~439 |
| 英文格式: | ZHANG Jun-hui,DI Zheng-lin,HE Zhi-yong,FENG Jian-Xiang,XU Rong-ming.Comparison of humeral head replacement and internal fixation for the treatment of 3 parts and 4 parts fractures of proximal humerus in the elderly[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(6):435~439 |
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