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ENGLISH ABSTRACT
切开复位内固定与肱骨头置换术对于肱骨近端粉碎性骨折患者肩关节功能恢复的疗效比较
吕文强
王涛
作者及单位信息
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DOI： 10.3760/cma.j.cn341190-20240628-00826
Efficacy of open reduction and internal fixation versus humeral head replacement in the recovery of shoulder joint function in patients with comminuted fractures of the proximal humerus
Lyu Wenqiang
Wang Tao
Authors Info & Affiliations
Lyu Wenqiang
Department of Orthopedics, Xi 'an Gaoxin Hospital, Xi'an 710075, Shaanxi Province, China
Wang Tao
Department of Orthopedics, Xi 'an Gaoxin Hospital, Xi'an 710075, Shaanxi Province, China
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DOI： 10.3760/cma.j.cn341190-20240628-00826
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摘要

目的比较切开复位内固定与肱骨头置换术对于肱骨近端粉碎性骨折患者肩关节功能恢复的疗效。

方法本研究为病例对照研究，选择2020年1月至2023年12月期间西安高新医院骨科接诊后采用手术治疗的肱骨近端粉碎性骨折患者80例的数据实施回顾性分析。依据手术方法不同将患者分为两组：对照组（ n=45）给予切开复位内固定治疗术，观察组（ n=35）给予肱骨头置换术。比较两组患者的手术相关指标、术后3个月的治疗效果评级、肩关节活动度、肩关节功能状态、并发症发生率。

结果观察组术中失血量、手术时间、术后引流量、术后住院时间分别为（186.92±28.04）mL、（68.89±10.12）min、（57.89±11.25）mL、（10.18±2.41）d，均明显低于对照组的（218.23±35.57）mL、（98.26±15.34）min、（73.65±13.68）mL、（12.35±2.92）d，差异均有统计学意义（ t=4.27、9.78、5.51、3.55，均 P < 0.05）。两组患者术后3个月的疗效差异无统计学意义［97.14%（34/35）比95.56%（43/45）］（ χ 2=0.04， P > 0.05）。观察组患者在治疗后3个月的前屈上举、外旋、内旋的角度分别为（95.42±7.88）°，（61.37±6.56）°，（74.38±5.01）°，对照组分别为（93.68±7.75）°，（60.42±6.87）°，（73.75±4.92）°，差异均无统计学意义（ t=-0.98、-0.62、-0.56，均 P > 0.05）。观察组在治疗后3个月的肩关节功能状态评分为（73.46±9.15）分，对照组为（71.75±8.66）分，差异无统计学意义（ t=-0.85， P > 0.05）。观察组并发症发生率为2.86%（1/35），明显低于对照组的22.22%（10/45），差异有统计学意义（ χ 2=4.70， P=0.030）。

结论针对肱骨近端粉碎性骨折患者，切开复位内固定与肱骨头置换术两种方法均可以取得很好的肩关节功能恢复，而肱骨头置换术在围手术期的优势更为明显。

肱骨;骨折，粉碎性;骨折切开复位;骨折固定术，内;关节成形术，置换;肩关节;失血，手术;手术后并发症
ABSTRACT

ObjectiveTo evaluate the effect of open reduction and internal fixation versus humeral head replacement on postoperative recovery of shoulder joint function in a population of patients with comminuted fractures of the proximal humerus.

MethodsThis study was a case-control study that retrospectively analyzed data from 80 patients with comminuted fractures of the proximal humerus who underwent surgical treatment at the Department of Orthopedics at Xi'an Gaoxin Hospital from January 2020 to December 2023. The patients were divided into two groups based on the surgical method: the control group ( n = 45) received open reduction and internal fixation, while the observation group ( n = 35) underwent humeral head replacement. Surgery-related indexes, as well as therapeutic effect ratings, shoulder joint mobility, and shoulder joint function 3 months post-surgery, were compared between the two groups. Additionally, the incidence of complications occurring during the treatment was also compared between the two groups.

ResultsIn the observation group, the intraoperative blood loss, surgery duration, postoperative drainage amount, and length of hospital stay were (186.92 ± 28.04) mL, (68.89 ± 10.12) minutes, (57.89 ± 11.25) mL, and (10.18 ± 2.41) days, respectively, all of which were significantly lower than those in the control group, which were (218.23 ± 35.57) mL, (98.26 ± 15.34) minutes, (73.65 ± 13.68) mL, and (12.35 ± 2.92) days ( t = 4.27, 9.78, 5.51, 3.55, all P < 0.05). There was no statistically significant difference in the therapeutic effect between the two groups 3 months post-surgery [97.14% (34/35) vs. 95.56% (43/45), χ 2 = 0.04, P > 0.05]. At 3 months post-surgery, the angles of forward elevation, external rotation, and internal rotation in the observation group were (95.42 ± 7.88)°, (61.37 ± 6.56)°, and (74.38 ± 5.01)°, respectively, while in the control group they were (93.68 ± 7.75)°, (60.42 ± 6.87)°, and (73.75 ± 4.92)°, respectively. The differences were not statistically significant between the two groups ( t = -0.98, -0.62, -0.56, all P > 0.05). At 3 months post-surgery, the shoulder function score in the observation group was (73.46 ± 9.15), which was not significantly different from that in the control group [(71.75 ± 8.66), t = -0.85, P > 0.05]. The incidence of complications in the observation group was 2.86% (1/35), which was significantly lower than that in the control group [22.22% (10/45), χ 2 = 4.70, P = 0.030).

ConclusionsFor patients with comminuted fractures of the proximal humerus, both open reduction and internal fixation and humeral head replacement can achieve good shoulder joint function recovery. However, humeral head replacement is more advantageous than open reduction and internal fixation during the perioperative period.

Humerus;Fractures, comminuted;Open fracture reduction;Fracture fixation,internal;Arthroplasty,replacement;Shoulder joint;Blood loss,surgical;Postoperative complications
Wang Tao, Email: mocdef.qabq5985843
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引用本文

吕文强,王涛. 切开复位内固定与肱骨头置换术对于肱骨近端粉碎性骨折患者肩关节功能恢复的疗效比较[J]. 中国基层医药,2025,32(03)：414-419.

DOI:10.3760/cma.j.cn341190-20240628-00826

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肱骨近端的骨折情况普遍，涉及的位置是肱骨大结节基底以上的区域，由于此处骨骼结构的特殊性，对于外力的承受力较弱，故骨折概率较高 ［ 1 , 2 ］ 。这类骨折约占全身骨折总数的4%～5%；而在60岁以上的人群中，其发生率可高达70%，特别是对于65岁以上的老年人，其发病率仅次于髋部和桡骨远端骨折，成为这一年龄段常见的骨折类型 ［ 3 , 4 ］ 。有研究显示，肱骨近端骨折的发病年龄有两个高峰，分别是30岁左右的青年人和60岁以上的老年人，其中老年人由于骨质疏松和低能量损伤的易感性，构成了主要的高风险群体 ［ 5 , 6 ］ 。随着社会经济发展，人口老龄化趋势加速，加上交通事故增多以及暴力接触机会增加，预计在未来30年内，此类骨折的发病率可能会上升3倍以上 ［ 7 ］ 。目前，老年肱骨近端骨折的处理方法多样，但缺乏统一的治疗标准，特别是对于Neer分型为Ⅲ型或Ⅳ型的复杂骨折 ［ 8 , 9 , 10 , 11 ］ 。手术治疗包括内固定和人工肱骨头置换，其目标是稳定肩关节，促进早期功能锻炼和肩关节功能的恢复。然而，关于这两种手术方法的优缺点，目前还存在争议 ［ 8 , 9 , 10 , 11 ］ ，需要更多数据来支持相关研究。本研究旨在比较切开复位内固定与肱骨头置换术治疗肱骨近端粉碎性骨折的疗效和肩关节功能恢复上的差异。现报告如下。
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备注信息
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王涛，Email： mocdef.qabq5985843
B

吕文强：酝酿和设计实验，采集数据，起草文章等；王涛：分析/解释数据，统计分析，采集数据，对文章的知识性内容作批评性审阅等

C
吕文强, 王涛. 切开复位内固定与肱骨头置换术对于肱骨近端粉碎性骨折患者肩关节功能恢复的疗效比较[J]. 中国基层医药,2025,32(3):414-419. DOI:10.3760/cma.j.cn341190-20240628-00826.
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