中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (19): 2974-2980.doi: 10.3969/j.issn.2095-4344.0228

• 人工假体 artificial prosthesis • 上一篇    下一篇

肱骨近端三、四部分骨折治疗:半肩关节置换与锁定钢板对比

冯  硕,查国春,郭开今,杨 志,常步青,杨 硕,徐崇峻,陈向阳   

  1. 徐州医科大学附属医院骨科,江苏省徐州市   221000
  • 出版日期:2018-07-08 发布日期:2018-07-08
  • 通讯作者: 陈向阳,博士,主任医师,徐州医科大学附属医院骨科,江苏省徐州市 221000
  • 作者简介:冯硕,男,1993年生,安徽省宿州市人,汉族,徐州医科大学在读硕士,目前从事骨外科等方面的研究。
  • 基金资助:

    江苏省青年医学人才项目(QNRC2016800);徐州市科技计划项目(KC16SL111);江苏省卫计委面上项目(H201528);江苏省级社会发展重点项目(BE2015627);徐州市科技项目(KC14SH091)

Clinical outcomes of three- or four-part complex proximal humerus fractures: hemiarthroplasty versus locking plate fixation

Feng Shuo, Zha Guo-chun, Guo Kai-jin, Yang Zhi, Chang Bu-qing, Yang Shuo, Xu Chong-jun, Chen Xiang-yang   

  1. Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Online:2018-07-08 Published:2018-07-08
  • Contact: Chen Xiang-yang, M.D., Chief physician, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • About author:Feng Shuo, Master candidate, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Supported by:

     the Youth Medical Talent Project of Jiangsu Province, No. QNRC2016800; the Science and Technology Plan Project of Xuzhou City, No. KC16SL111; the General Program of Health Planning Commission of Jiangsu Province, No. H201528; the Key Social Development Project of Jiangsu Province, No. BE2015627; the Science and Technology Program of Xuzhou City, No. KC14SH091

摘要:

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文题释义:
肱骨近端三、四部分骨折:Neer所提出此肱骨近端骨折的分类方法,通常肱骨近端由肱骨头、大结节、小结节和肱骨上端4个部分组成部分,肱骨近端发生骨折累及三个部分(三部分大结节、三部分小结节)或四个部分且每部分骨折以移位大于1 cm或成角畸形大于45°的骨折称为肱骨近端三、四部分骨折。
半肩关节置换:根据人体肩关节近端肱骨头的构造及功能,采用金属等材料制成人工肱骨头关节假体,通过外科技术置入人体内,代替患病关节功能,达到缓解关节疼痛,重建肩关节功能一种术式。
 
摘要
背景:对于肱骨近端三、四部分骨折选择半肩关节置换还是锁定钢板内固定治疗仍然存在较大的争议。
目的:对比半肩关节置换及锁定钢板内固定治疗肱骨近端三、四部分骨折的临床疗效及差异。
方法:回顾分析73例肱骨近端骨折患者的临床资料,其中半肩关节置换组22例,锁定钢板内固定组51例。分析并比较2组患者术前资料、手术相关指标、术后并发症发生情况及末次随访肩关节Constant-Murley评分等。
结果与结论:①73例患者术后获得6-24个月随访;②锁定钢板内固定组与半肩关节置换组相比,其手术时间长、术后引流量多且术后血红蛋白水平明显降低,差异有显著性意义(P < 0.05);③锁定钢板内固定组的总并发症发生率35%虽然高于半肩关节置换组23%,但差异无显著性意义;④术后末次随访Constant-Murley总评分锁定钢板内固定组显著高于半肩关节置换组,差异有显著性意义(P < 0.05);⑤三部分骨折患者,采用锁定钢板内固定的末次随访Constant-Murley评分明显优于半肩关节置换(P < 0.05),锁定钢板内固定较半肩关节置换手术时间更长,血红蛋白下降值更低(P < 0.05);⑥对于四部分骨折患者,2种治疗方式末次随访Constant-Murley评分差异无显著性意义(P > 0.05),但锁定钢板内固定的手术时间更长,血红蛋白下降值更低,且并发症发生率明显高于半肩关节置换(P < 0.05);⑦总体而言,肱骨近端三、四部分骨折锁定钢板内固定患者肩关节功能恢复优于半肩关节置换,其中肱骨近端三部分骨折采用锁定钢板内固定治疗的修复结果要优于半肩关节置换,对于四部分骨折而言二者效果并无太多差异,但锁定钢板内固定手术时间较长,出血多,并发症的发生率较高。

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
ORCID: 0000-0002-3708-117X(冯硕)

关键词: 半肩关节置换, 肱骨, 骨折, 锁定钢板, 人工假体, 内固定, 疗效, 骨科植入物

Abstract:

BACKGROUND: There is controversy over the choice of hemiarthroplasty or locking plate fixation for the treatment of three- or four-part complex proximal humerus fractures.

OBJECTIVE: To compare the clinical outcomes and difference between hemiarthroplasty and locking plate fixation in the treatment of three- or four-part complex proximal humerus fractures
METHODS: Clinical data of 73 patients with three or four parts complex proximal humerus fractures were retrospectively analyzed. 22 cases underwent hemiarthroplasty, and 51 cases received locking proximal humeral plate fixation. The preoperative data, surgery-related indicators, postoperative complications and shoulder Constant-Murley score were analyzed and compared between the two groups.
RESULTS AND CONCLUSION: (1) Totally 73 patients were followed up for 6 to 24 months. (2) Compared with the hemiarthroplasty group, the operation time was longer; the postoperative drainage volume increased and the hemoglobin decreased significantly in the locking plate fixation group (P < 0.05). (3) The overall complication rate (35%) in the locking plate fixation group was higher than that in the hemiarthroplasty group (23%), but no significant difference was found. (4) The total Constant-Murley score in the locking plate group was significantly higher than that in the hemiarthroplasty group in final follow-up post operation (P < 0.05). (5) In three-part fractures patients, Constant-Murley score was significantly higher in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). Operation time was longer and a decrease in hemoglobin level was lower in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). (6) In four-part fractures patients, no significant difference in Constant-Murley score was determined between the two groups (P > 0.05). However, operation time was longer; a decrease in hemoglobin level was lower; and in the incidence of complications was higher in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). (7) In conclusion, the shoulder joint function of overall the three- or four-part fracture of the proximal humerus fractures treated with locking plate was better than that of the hemiarthroplasty. The clinical outcome of locking plate internal fixation for the three-part proximal humerus is superior to that of hemiarthroplasty. For the four-part fracture, there is not much difference between the two treatments, but locking plate internal fixation has longer operation time, more bleeding and higher incidence of complications.

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

Key words: Humerus, Fractures, Bone, Prosthesis Implantation, Arthroplasty, Replacement, Tissue Engineering

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