中医正骨
中醫正骨
중의정골
THE JOURNAL OF TRADITIONAL CHINESE ORTHOPEDICS AND TRAUMATOLOGY
2015年
8期
11-14,17
,共5页
肩骨折%肱骨骨折%骨折固定术,内%骨板%关节成形术,置换%治疗,临床研究性
肩骨摺%肱骨骨摺%骨摺固定術,內%骨闆%關節成形術,置換%治療,臨床研究性
견골절%굉골골절%골절고정술,내%골판%관절성형술,치환%치료,림상연구성
shoulder fractures%humeral fractures%fracture fixation,internal%bone plates%arthroplasty,replacement%therapies,investigational
目的：比较切开复位锁定钢板内固定术和人工半肩关节置换术治疗老年肱骨近端复杂骨折的临床疗效和安全性。方法：回顾性分析2011年2月至2013年11月收治的47例老年肱骨近端复杂骨折患者的病例资料，30例采用切开复位锁定钢板内固定术治疗（锁定钢板组），其余17例采用人工半肩关节置换术治疗（关节置换组）。比较2组患者的手术时间、术中出血量、Con-stant －Murley 评分及并发症发生率。结果：2组患者手术时间、术中出血量及 Constant－Murley 评分比较，组间差异均无统计学意义[（93．5±10．2）min，（89．2±8．4）min，t ＝1．476，P ＝0．147；（267．3±20．6）mL，（261．9±18．4）mL，t ＝1．023，P ＝0．312；（63．4±4．2）分，（65．2±3．6）分，t ＝－0．558，P ＝0．560]。47例患者均获随访，随访时间12～18个月，中位数15个月。术后锁定钢板组5例发生内固定松动或断裂、1例发生肱骨头坏死，至随访结束时关节置换组未发生相关并发症；2组并发症发生率比较，差异无统计学意义（P ＝0．074）。结论：切开复位锁定钢板内固定术和人工半肩关节置换术均为治疗老年肱骨近端复杂骨折的有效术式，二者的临床疗效和安全性相当。
目的：比較切開複位鎖定鋼闆內固定術和人工半肩關節置換術治療老年肱骨近耑複雜骨摺的臨床療效和安全性。方法：迴顧性分析2011年2月至2013年11月收治的47例老年肱骨近耑複雜骨摺患者的病例資料，30例採用切開複位鎖定鋼闆內固定術治療（鎖定鋼闆組），其餘17例採用人工半肩關節置換術治療（關節置換組）。比較2組患者的手術時間、術中齣血量、Con-stant －Murley 評分及併髮癥髮生率。結果：2組患者手術時間、術中齣血量及 Constant－Murley 評分比較，組間差異均無統計學意義[（93．5±10．2）min，（89．2±8．4）min，t ＝1．476，P ＝0．147；（267．3±20．6）mL，（261．9±18．4）mL，t ＝1．023，P ＝0．312；（63．4±4．2）分，（65．2±3．6）分，t ＝－0．558，P ＝0．560]。47例患者均穫隨訪，隨訪時間12～18箇月，中位數15箇月。術後鎖定鋼闆組5例髮生內固定鬆動或斷裂、1例髮生肱骨頭壞死，至隨訪結束時關節置換組未髮生相關併髮癥；2組併髮癥髮生率比較，差異無統計學意義（P ＝0．074）。結論：切開複位鎖定鋼闆內固定術和人工半肩關節置換術均為治療老年肱骨近耑複雜骨摺的有效術式，二者的臨床療效和安全性相噹。
목적：비교절개복위쇄정강판내고정술화인공반견관절치환술치료노년굉골근단복잡골절적림상료효화안전성。방법：회고성분석2011년2월지2013년11월수치적47례노년굉골근단복잡골절환자적병례자료，30례채용절개복위쇄정강판내고정술치료（쇄정강판조），기여17례채용인공반견관절치환술치료（관절치환조）。비교2조환자적수술시간、술중출혈량、Con-stant －Murley 평분급병발증발생솔。결과：2조환자수술시간、술중출혈량급 Constant－Murley 평분비교，조간차이균무통계학의의[（93．5±10．2）min，（89．2±8．4）min，t ＝1．476，P ＝0．147；（267．3±20．6）mL，（261．9±18．4）mL，t ＝1．023，P ＝0．312；（63．4±4．2）분，（65．2±3．6）분，t ＝－0．558，P ＝0．560]。47례환자균획수방，수방시간12～18개월，중위수15개월。술후쇄정강판조5례발생내고정송동혹단렬、1례발생굉골두배사，지수방결속시관절치환조미발생상관병발증；2조병발증발생솔비교，차이무통계학의의（P ＝0．074）。결론：절개복위쇄정강판내고정술화인공반견관절치환술균위치료노년굉골근단복잡골절적유효술식，이자적림상료효화안전성상당。
Objective:To compare the clinical curative effects and safety of open reduction and locking plate internal fixation versus ar-tificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients.Methods:The medical records of 47 old pa-tients with complicated proximal humeral fractures from February 201 1 to November 201 3 were analyzed retrospectively.Thirty patients(loc-king plate group)were treated with open reduction and locking plate internal fixation,while the others(hemiarthroplasty group)were treated with artificial shoulder hemiarthroplasty.Then the two groups were compared with each other in operative time,intraoperative blood loss, Constant -Murley scores and complication rates.Results:There was no statistical difference in the operative time,intraoperative blood loss and Constant -Murley scores between the 2 groups(93.5 +/-1 0.2 vs 89.2 +/-8.4 min,t =1 .476,P =0.1 47;267.3 +/-20.6 vs 261 .9 +/-1 8.4 mL,t =1 .023,P =0.31 2;63.4 +/-4.2 vs 65.2 +/-3.6 points,t =-0.558,P =0.560).All patients in the 2 groups were followed up for 1 2 -1 8 months with a median of 1 5 months.Loosening or fragmentation of the internal fixators(5 cases)and humeral head necrosis(1 case)were found in the locking plate group after the surgery,while no related complications were found in hemiarthroplasty group during the follow-up period.There was no statistical difference in the complication rate between the 2 groups(P =0.074).Conclu-sion:Open reduction and locking plate internal fixation is similar to artificial shoulder hemiarthroplasty in the curative effect and safety,and both of them are effective method for treatment of complicated proximal humeral fractures in old patients.
