半肩关节置换治疗老年肱骨近端复杂骨折(1)

http://www.100md.com 2020年5月5日 《中外医疗》 202013

     [摘要] 目的 以老年肱骨近端復杂骨折患者作为研究对象，分析患者采用半肩关节置换治疗的效果。 方法 于2017年6月—2019年11月随机抽取该院收治的22例老年肱骨近端骨折患者分成治疗组(n=12)与对比组(n=10)，为对比组实施切开复位锁定钢板内固定术，为治疗组实施半肩关节置换术。 结果 治疗组术中出血量(272.34±21.15)mL较对比组(289.34±19.46)mL少，手术时间治疗组(86.55±5.64)min)较对比组(98.67±5.49)min短(t=4.194、3.698，P<0.05)。对比两组术后肌力、关节活动范围、日常生活活动、疼痛等Constant-Murley各项指标评分及总分差异有统计学意义(P<0.05)。治疗组：优6例(50.00%)、良5例(41.67%)、可1例(8.33%)、差0例(0.00%)、优良率达91.67%，对比组：优4例(40.00%)、良3例(30.00%)、2例(20.00%)、差1例(10.00%)、优良率达70.00%，治疗组恢复优良率明显较对比组高(χ2=6.149，P<0.05)。对比组肱骨头坏死1例(10.00%)、结节损伤2例(20.00%)、切口感染3例(30.00%)及术后僵硬2例(20.00%)等术后相关并发症发生率均高于治疗组0例(0.00%)、1例(8.33%)、1例(8.33%)、0例，各项指标发生率组间对比差异有统计学意义(χ2=3.081、4.227、3.915、3.522，P<0.05)。结论 老年肱骨近端复杂骨折患者采用半肩关节置换治疗有助于促进其术后恢复并可显著减少切口感染等相关并发症。

    [关键词] 半肩关节置换;老年肱骨近端复杂骨折;治疗效果

    [Abstract] Objective To analyze the effects of hemi-shoulder joint replacement on elderly patients with complex fractures of the proximal humerus. Methods Twenty-two elderly patients with proximal humerus fractures from June 2017 to November 2019 were randomly divided into a treatment group (n=12) and a comparison group (n=10). An open reduction and locking plate internal fixation were performed for the comparison group and a hemi-shoulder joint was performed replacement for the treatment group. Results The intraoperative blood loss in the treatment group was (272.34±21.15) mL less than that in the control group (289.34±19.46) mL. The operation time in the treatment group was (86.55±5.64) min shorter than that in the comparison group (98.67±5.49) min(t=4.194，3.698， P<0.05). There were statistically significant differences in the scores and total scores of the Constant-Murley indicators such as postoperative muscle strength， range of joint activity， daily activities， and pain between the two groups(P<0.05). Treatment group： excellent 6 cases(50.00%)， good 5 cases(41.67%)， fair 1 cases(8.33%)， poor 0 cases(0.00%)， excellent rate 11 cases(91.67%)， comparison group： excellent 4 cases(40.00%)， good 3 cases(30.00%)， 2 cases(20.00%)， poor 1 cases(10.00%)， excellent and good rate of 7 cases(70.00%)， the excellent and good recovery rate in the treatment group was significantly higher than the control group(χ2=6.149， P<0.05). The humeral head necrosis 1 cases(10.00%)， nodular injury 2 cases(20.00%)， incision infection 3 cases(30.00%)， and postoperative stiffness 2 cases(20.00%) in the comparison group were all more common than those in the treatment group， 0 cases， 1 cases(8.33%)， 1 cases(8.33%)， 0 cases(0.00%)， higher. There was a statistically significant difference in the incidence of each index between groups(χ2=3.081， 4.227，3.915，3.522， P<0.05). Conclusion Hemi-shoulder arthroplasty in elderly patients with complex fractures of the proximal humerus can promote postoperative recovery and significantly reduce related complications such as incision infection.(余雪峰 黄正学 赵家联 杨新波 张春杰 段恒都)

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