两种手术方式治疗老年肱骨近端Neer四部分骨折的疗效比较

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摘要目的比较锁定加压钢板(locking compression plate，LCP)与半肩关节置换术(half shoulder replacement，HSR)治疗老年肱骨近端Neer四部分骨折的疗效。方法采用回顾性病例对照研究分析2017年11月至2019年11月华北医疗健康集团总医院收治的37例老年肱骨近端Neer四部分骨折患者的临床资料，其中男14例，女23例；年龄62～73岁，平均(68.5±5.5)岁。20例行切开复位LCP内固定(LCP组)，17例行HSR(HSR组)。比较两组切口长度、手术时间、术中出血量、术后并发症发生率，以及术后1、3、6及12个月的肩关节功能Neer评分、疼痛视觉模拟评分(visual analogue scale，VAS)。结果 37例患者均获随访，随访时间12～22个月，平均(16.5±4.5)个月。LCP组手术时间及术中出血量均少于HSR组(P＜0.01)，两组切口长度差异无统计学意义(P＞0.05)。HSR组术后1、3个月肩关节Neer评分优于LCP组(P＜0.01)，术后6个月时两组差异无统计学意义(P＞0.05)，但术后12个月LCP组肩关节Neer评分优于HSR组(P＜0.01)。术后12个月疗效采用Neer评分标准评定：LCP组优6例，良10例，可2例，差2例；HSR组优2例，良6例，可5例，差4例；LCP组疗效优于HSR组(P＜0.01)。HSR组术后1个月、3个月VAS优于LCP组(P＜0.01)，术后6个月两组差异无统计学意义(P＞0.05)，但术后12个月LCP组VAS优于HSR组(P＜0.01)。结论对于老年肱骨近端Neer四部分骨折，切开复位LCP内固定治疗较HSR手术时间短、术中出血量少，远期患肢功能恢复更好，疼痛缓解更明显。

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	游小军
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	何举仁

关键词 ：肱骨骨折, 骨折内固定术, 半肩置换

Abstract：Objective To compare the efficacy of locking compression plate (LCP) and half shoulder replacement (HSR) in the treatment of elderly proximal humeral Neer four-part fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 37 elderly patients with Neer four-part fractures of the proximal humerus who were admitted to General Hospital of North China Msedical & Health Group Xingtai from November 2017 to November 2019.14 males and 23 females were included.The patients’ age ranged from 62 to 73 years (68.5±5.5 years).20 cases underwent open reduction and LCP internal fixation (LCP group)，and 17 cases underwent HSR (HSR group).The incision length，operation time，intraoperative blood loss，postoperative complication rate，and Neer score and visual analog scale(VAS) of shoulder joint function at 1，3，6 and 12 months after operation were compared between the two groups.Results All patients were followed up for 12~22 months (16.5±4.5 months).The operation time and the amount of intraoperative blood loss in the LCP group were less than those in the HSR group (P＜0.01)，The incision length of the two groups was not statistically significant (P＞0.05).The Neer scores of the shoulder joint in the HSR group were better than those in the LCP group at 1 month and 3 months after operation (P＜0.01) There was no significant difference between the two groups at 6 months after surgery (P＞0.05) But at 12 months after surgery，the Neer score of the shoulder joint in the LCP group was better than the HSR group (P＜0.01).The curative effect at 12 months after operation was evaluated by Neer scoring standard.In the LCP group，6 cases were excellent，10 cases were good，2 cases were fair，and 2 cases were poor.In the HSR group，2 cases were excellent，6 cases were good，5 cases were fair，and 4 cases were poor (P＜0.01).The VAS in the HSR group were better than the LCP group at 1 month and 3 months after operation (P＜0.01).There was no statistically significant difference between the two groups at 6 months after surgery (P＞0.05)，but the VAS of the LCP group was better than the HSR group after 12 months after surgery(P＜0.01).Conclusion For elderly Neer four-part fractures of the proximal humerus，open reduction and LCP internal fixation have a shorter operation time and less intraoperative blood loss than HSR.The long-term function recovery of the affected limb is better and the pain relief is more obvious.

Key words： humeral fractures internal fixation of fracture half shoulder replacement

基金资助:河北省卫健委科技计划项目(20191185)

作者简介: 游小军(1972－ )，男，副主任医师，华北医疗健康集团邢台总医院骨科，494919891@qq.com

引用本文:

游小军，张宇，姬谨威，刘海波，张培培，何举仁. 两种手术方式治疗老年肱骨近端Neer四部分骨折的疗效比较[J]. 实用骨科杂志, 2022, 28(7): 590-595.
You Xiaojun，Zhang Yu，Ji Jinwei，Liu Haibo，Zhang Peipei，He Juren. Comparison of the Effect of Two Surgical Methods in the Treatment of Senile Proximal Humeral Neer Four-Part Fractures. sygkzz, 2022, 28(7): 590-595.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I7/590

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