目的：比较肱骨头置换术与锁定钢板内固定治疗老年肱骨近端粉碎性骨折近期效果。方法对74例≥75岁老年肱骨近端粉碎性骨折患者按手术方法分为肱骨头置换组( A组,n=39)和钢板内固定组( B组, n=35),A组行肱骨头置换术,B组行切开复位锁定钢板内固定。记录两组患者手术情况,比较两组患者术后并发症及康复情况,利用Constant-Murley肩关节功能评分系统评估肩关节功能恢复情况。结果手术时间：A组为(88．9±8．1) min,短于B组的(105．7±11．2) min(P<0．001)。住院时间：A组为(10．4±1．3) d,短于B组的(14．3±1．8) d(P<0．001)。出血量：A组为(186．5±29．6) ml,少于B组的(237．2±50．3) ml(P<0．001)。术后引流量：A组为(59．7±6．1) ml,少于B组的(81．3±8．2) ml(P<0．001)。患者均获得随访,时间26~35(30．3±3．5)个月。术后肩关节内收角度：A组为43°(41°~49°),大于B组的29°(27°~33°)；外展角度：A组为81°(78°~84°),大于B组的70°(68°~73°)；内旋角度：A组为30°(28°~34°),大于B组的22°(19°~24°)；外旋角度：A组为34°(31°~37°),大于B组的18°(16°~22°)；以上各项差异均有统计学意义(P<0．001)。 Constant-Murley评分：A组为(79．4±2．7)分,高于B组的(67．3±3．1)分(P<0．001)。临床痊愈时间：A组为(9．7±1．9)周,短于B组的(15．4±4．1)周(P<0．001)。术后并发症发生率：A组(12．8%)虽低于B组(25．7%),但差异无统计学意义(P>0．05)。结论肱骨头置换术治疗≥75岁老年肱骨近端粉碎性骨折具有手术时间短、出血量少、肩关节功能恢复快、术后并发症少等优点,近期效果确切。%Objective To investigate the short term effect of hemiarthroplasty and locking plate internal fixation in treatment of comminuted fracture of proximal humerus in the elderly. Methods 74 cases of patients ( aged≥75 years) with proximal humerus comminuted fracture underwent elective surgery were divided into the humeral head re-placement group (group A,n=39) and plate internal fixation group (group B, n=35). Patents in group A under-went hemiarthroplasty surgery,while in group B underwent open reduction and locking plate internal fixation. The op-eration situations of the two groups were recorded. The postoperative complications and the rehabilitation of the two groups were compared. The shoulder joint function recovery was assessed by using Constant-Murley shoulder score sys-tem. Results Operation time:group A was (88. 9 ± 8. 1) min,shorter than group B (105. 7 ± 11. 2) min (P<0. 001). Hospital stay:group A was (10. 4 ± 1. 3) d,shorter than group B (14. 3 ± 1. 8) d (P<0. 001). The bleed-ing:group A was (186. 5 ± 29. 6) ml, less than group B (237. 2 ± 50. 3) ml (P<0. 001). The postoperative drain-age:group A was (59. 7 ± 6. 1) ml, less than group B (81. 3 ± 8. 2) ml, (P<0. 001). All patients were followed up for 26~35 (30. 3 ± 3. 5) months. Postoperative shoulder adduction angle: group A was 43°(41° ~49°), more than group B 29°(27°~33°);abduction angle:group A was 81°(78°~84°), more than group B 70°(68°~73°);internal rotation angle:group A was 30°(28° ~34°), more than B group 22°(19° ~24°);external rotation angle:group A was 34°(31°~37°), more than group B 18°(16°~22°);the differences were statistically significant (P<0. 001). Constant-Murley score:group A was (79. 4 ± 2. 7) points, higher than group B (67. 3 ± 3. 1) points (P<0. 001). Clinical recovery time:group A was (9. 7 ±1. 9) weeks, shorter than group B (15. 4 ±4. 1) weeks (P<0. 001). Incidence of postoperative complications:group A was 12. 8%, lower than group B 25. 7%,but there were no significant differences in the two groups (P>0. 05). Conclusions The hemiarthroplasty in treatment of aged≥75 years patients has the advantages of shorter operative time, less blood loss, faster recovery of shoulder function, fewer complications, etc. The short term effects are exact.
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